Dr. C. Everett Koop, the Reagan administration's choice for surgeon general, has predicted that legalized abortion could lead to the compulsory killing of imperfect babies and sick old people by the end of this century.

This and other tenets of Koop's philosophy -- that population control represents "national suicide," that Planned Parenthood is to blame for teen-agers' sexual activity and that test-tube baby programs may be used in the future to increase the political power of homosexuals -- are contained in a speech Koop delivered in 1979 at the commencement of the Philadelphia College of Osteopathic Medicine.

Parts of teh speech read like tongue-in-cheek science fiction, but Koop is serious about the general scenario it describes, and has predicted similar events in many of his other writings.

In the speech, Koop -- who resigned from the boards of several right-to-life groups to become Reaganhs deputy assistant secretary for health -- predicted a medical "domino theory" in which abortion, by cheapening human life, would lead to government persecuton of religion, the slaughter of defective newborn babies and court-ordered euthanasia for the senile, the sick and the elderly.

Speaking as if he were looking backward from 1999, he told his listeners that the 1973 Supreme Court decision legalizing abortion "has made your life what it is today and will determine how you will die and perhaps when."

The surgeon general is the head of the Public Health Service commissined corps, and is the official adviser to the American people on health matters. Because of the influence the post commands, Koop's views have alarmed advocates not only of abortion but of population control, gay rights, prenatal diagnosis of birth defects and other causes he opposes.

Koop, a Philadelphia pediatric surgeon famous for operations to separate joined twins, assumed his duties in March as deputy assistant secretary for health in the Department of Health and Human Services. His nomination as surgeon general has been held up because it requires Congress to amend the law stipulating that nominees to the post must be under age 64. Koop was 64 last Oct. 14.

Koop introduced himself in the speech as an 82-year-old addressing the graduating class of 1999. He said he had been released from a "detention center" for the occasion, and reminisced about American events during the last quarter of the 20th century.

After the legalization of abortion, he said, "secular humanism became the state antireligion in 1989," and it was "illegal to mention God seriously after 1984." Infanticide -- which Koop dubbed "the second domini" -- was legalized, and in 1985 "it became illegal for obstetrician to deliver a defective baby that could hve been diagnosed before birth."

After 1987, he said, "no child was delcared alive until 72 hours after birth in order to let its parents decide whether they wanted the baby or not."

As a result, he said, the imaginary 1999 graduates sitting before him were a class of "only perfect specimens -- no defects, no eyeglasses, no balding young men! I cannot get use to seeing such a preponderance of boys. But now that sex determination is possible, people get what they want . . ."

He said his third domino fell when the Supreme Court decided in favor of voluntary euthanasia, "which, of course, led to the compulsory euthanasia decision of the Surpreme Court in 1995 for the infirm, the senile, and . . . those over 80 who failed the comprehensive test for longevity." Abortion, infantcide and euthanasia represented the triumph of "sociologic law," in which representative government was circumvented by "a small elite group working through the courts."

A spokesman for the Philadelphia College of Osteopathic Medicine said the speech elicited an "unprecedented standing ovation" when the imposing, bearded surgeon delivered it in June 1979.

The Philadelphia speech was not the only time Koop has expressed such thoughts. In a 1978 article in the Journal of the Medicine Society of New Jersey, for example, he said, "I can see prophetically a progression of thinking in this country from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

A year later similar sentiments were offered in an antiaborition book, "Whatever Happened to the Human Race?," written by Koop and Francis A. Schaeffer, a philosopher: "Abortion . . . has moved from something once considered unusual and now in many cases is an accepted form of birth control. Infanticide is following the same pattern. . . . Once the doors are open, there is no reason why the aged, weak and infirm will not find that as they become economic burdens they will be eliminated under one pretext or another."

"I'm very concerned about his philosophy," said Rep. Henry Waxman (D-Calif.), chairman of the House subcommittee considering the amendment to abolish the age restriction for surgeon generals. "His intolerant attitude and almost paranoid statements about family planning, amniocentesis [a test conducted during pregnancy to determine birth defects] and abortion, and the motives of those who favor those kinds of positions, make me very worried about how he would perform . . . as chief health officer of the country."

Koop declined to be interviewed, and has refused to testify before Waxman's subcommittee. Other officials of the Department of Health and Human Services also declined to comment, on the grounds that Koop has not yet been officially nominated as surgeon general.

Koop's supporters characterize him as a compassionate, deeply religious man and a talented administrator whose philosophy is not likely to interfere with his performance as surgeon general.

"My impression is that Koop will be outstanding," said Dr. Juday Dolkman, surgeon-in-chief at Children's Hospital Medical Center in Boston and Koop's longtime friend and colleague. "I also know Dr. Richmond [Dr. Julius Richmond, surgeon general under president Jimmy Carter] very well. In many respects, they're very similar in their compassion for indigent patients, for children . . ."

Folkman said he and Koop differed on abortion, but that he had always found Koop willing to listen to his views. "He has some very important points that one has to be concerned about," Folkman said. "He's trying to show that if you have a gradual disrespect for the sanctity of life, it's very hard to reverse it.

"He's a very strong person, very articulate and has lots of different philosophies that stem from his religion," Folkman continued. "I don't know to what extent that would affect his professional work except it benefit it. . . . He's a man of the highest principles and consummate professional skill, both surgical and otherwise."

In the Philadelphia speech, Koop also said that he had sued Planned Parenthood "because they had not planned a single parenthood in years: Converted adolescent innocence into sexually active . . . teen-agers is more like it."

He said he lost the case, and that the American population subsequently plummeted due to the combined effects of population control programs, an epidemic of Legionnaire's disease and a plot by "the group called Ecology Forever" to sterilize 11 million citizens of New York, Philadelphia and Washington. Koop has never sued Planned Parenthood, according to a spokesman for that organization.

"I have always thought this over-concern with population was a national suicide, a death wish," Koop said.

He added that "underpopulation has finally united Russia, Europe, Canada and the United States to stand against the territorial need of overpopulated Asia and Africa."

Noting that two of the graduates in 1999 were test-tube babies, he said, "I cannot say that I look with any pleasure on the rockhead Foundation support of 100,000 homosexual and lesbian test-tube babies to give the gay movement more political clout in the future."

Koop closed by exhorting his listeners to "begin again with a biblical view of the sanctity of human life . . ." Then he announced, "I do have the last laugh. You see, I got my notice to report to the Suicide Center before June 30th. If I don't . . . I will undergo the demise provided by the compulsory euthanasia rule . . . . I will be in heaven soon."

At hearings conducted by Rep. Waxman on the amendment that would allow Koop to be nominated as surgeon general, critics focused on the doctor's lack of experience in the field of public health. But Dr. William McBeth, executive director of the American Public Health Association, said he was also worried about what he felt was Koop's apparent lack of tolerance for those with opposing views.

"We, of course, are strongly prochoice," McBeth said, referring to his organization, "yet we still maintain within our organization not only the right but the opportunity for dissent . . ."

Waxman said he feared that if Koop became surgeon general, his ideology might influence the direction of scientific might influence the direction of scientific research at the National Institutes of Health.

but Rep. Henry J. Hyde (r-Ill.) said he doubted that Koop's appointment would change the direction of the administration's health policy. "This man is obviously a superstar," he said. "American would be lucky to have a man of his talent and scope . . . This post is not one that is going to make policy. The administration is going to make policy, and I think his views on abortion are shared by this administration."

The surgeon general's control over policy has waxed and waned over the last two decades with changes in the structure of the Department of Health and Human Services. When Koop's nomination was proposed, he told The Philadelphia Inquirer that he had been assured his responsibilites would include the U.S. Public Health Service, the National Institute of Health, the Centers for Disease Control and the Alcohol, Drug Abuse and Mental Health Administration.

Those agencies are now supervised by Koop's superior, Dr. Edward N. Brandt, the assistant secretary for health. Under a plan to reorganize the department, Brandt would be promoted to undersecretary for health and Koop's duties would also presumably expand. But a department spokeswoman said that proposal was "just a plan," and that its implementation was "nowhere near in the future." Whatever the surgeon general's influence on health policy, the title carries considerable symbolic weight. "He becomes the spokesman on health issues, the ranking health professional in the government -- often viewed as the nation's top physician," said Dr. John C. Greene, dean of the school of dentistry at the University of California at San Francisco and deputy surgeon general during the Carter administration. "The surgeon general is viewed as sort of the counterpart to the attorney general of the United States."