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The document will be submitted this week to the Supreme Court in support of a suit seeking to strike down Proposition 8, a California ballot initiative barring same-sex marriage, and all similar bans. The court will hear back-to-back arguments next month in that case and another pivotal gay rights case that challenges the 1996 federal Defense of Marriage Act.

The Proposition 8 case already has a powerful conservative supporter: Theodore B. Olson, the former solicitor general under Mr. Bush and one of the suit's two lead lawyers. The amicus, or friend-of-the-court, brief is being filed with Mr. Olson's blessing. It argues, as he does, that same-sex marriage promotes family values by allowing children of gay couples to grow up in two-parent homes, and that it advances conservative values of "limited government and maximizing individual freedom."

Legal analysts said the brief had the potential to sway conservative justices as much for the prominent names attached to it as for its legal arguments. The list of signers includes a string of Republican officials and influential thinkers — 75 as of Monday evening — who are not ordinarily associated with gay rights advocacy, including some who are speaking out for the first time and others who have changed their previous positions.

Among them are Meg Whitman, who supported Proposition 8 when she ran for California governor; Representatives Ileana Ros-Lehtinen of Florida and Richard Hanna of New York; Stephen J. Hadley, a Bush national security adviser; Carlos Gutierrez, a commerce secretary to Mr. Bush; James B. Comey, a top Bush Justice Department official; David A. Stockman, President Ronald Reagan's first budget director; and Deborah Pryce, a former member of the House Republican leadership from Ohio who is retired from Congress.

Ms. Pryce said Monday: "Like a lot of the country, my views have evolved on this from the first day I set foot in Congress. I think it's just the right thing, and I think it's on solid legal footing, too."

Jon M. Huntsman Jr., the former Utah governor, who favored civil unions but opposed same-sex marriage during his 2012 presidential bid, also signed. Last week, Mr. Huntsman announced his new position in an article titled "Marriage Equality Is a Conservative Cause," a sign that the 2016 Republican presidential candidates could be divided on the issue for the first time.

"The ground on this is obviously changing, but it is changing more rapidly than people think," said John Feehery, a Republican strategist and former House leadership aide who did not sign the brief. "I think that Republicans in the future are going to be a little bit more careful about focusing on these issues that tend to divide the party."

Some high-profile Republicans who support same-sex marriage — including Laura Bush, the former first lady; Dick Cheney, the former vice president; and Colin L. Powell, a former secretary of state — were not on the list as of Monday.

But the presence of so many well-known former officials — including Christine Todd Whitman, former governor of New Jersey, and William Weld and Jane Swift, both former governors of Massachusetts — suggests that once Republicans are out of public life they feel freer to speak out against the party's official platform, which calls for amending the Constitution to define marriage as "the union of one man and one woman."

By contrast, the brief, shared with The New York Times by its drafters, cites past Supreme Court rulings dear to conservatives, including the Citizens United decision lifting restrictions on campaign financing, and a Washington, D.C., Second Amendment case that overturned a law barring handgun ownership.

"We are trying to say to the court that we are judicial and political conservatives, and it is consistent with our values and philosophy for you to overturn Proposition 8," said Ken Mehlman, the former chairman of the Republican National Committee, who came out as gay several years ago. He is on the board of the American Foundation for Equal Rights, which brought the California suit, and has spent months in quiet conversations with fellow Republicans to gather signatures for the brief.

In making an expansive argument that same-sex marriage bans are discriminatory, the brief's signatories are at odds with the House Republican leadership, which has authorized the expenditure of tax dollars to defend the 1996 marriage law. The law defines marriage in the eyes of the federal government as the union of a man and a woman.

Polls show that public attitudes have shifted drastically on same-sex marriage over the past decade. A majority of Americans now favor same-sex marriage, up from roughly one third in 2003.

While Republicans lag behind the general population — the latest New York Times survey found a third of Republicans favor letting gay people marry — that, too, is changing quickly as more young people reach voting age. Several recent polls show that about 70 percent of voters under 30 back same-sex marriage.

"The die is cast on this issue when you look at the percentage of younger voters who support gay marriage," said Steve Schmidt, who was a senior adviser to the 2004 Republican presidential nominee, Senator John McCain of Arizona, and who signed the brief. "As Dick Cheney said years ago, 'Freedom means freedom for everybody.' "

Still, it is clear that Republican backers of same-sex marriage have yet to bring the rest of the party around to their views. Mr. Feehery said there are regional as well as generational divisions, with opposition especially strong in the South. Speaking of Mr. Boehner, he said, "I doubt very seriously that he is going to change his position."

Experts say that amicus briefs generally do not change Supreme Court justices' minds. But on Monday some said that the Republican brief, written by Seth P. Waxman, a former solicitor general in the administration of President Bill Clinton, and Reginald Brown, who served in the Bush White House Counsel's Office, might be an exception.

Tom Goldstein, publisher of Scotusblog, a Web site that analyzes Supreme Court cases, said the amicus filing "has the potential to break through and make a real difference."

He added: "The person who is going to decide this case, if it's going to be close, is going to be a conservative justice who respects traditional marriage but nonetheless is sympathetic to the claims that this is just another form of hatred. If you're trying to persuade someone like that, you can't persuade them from the perspective of gay rights advocacy."

LUXOR, Egypt (AP) — An Egyptian security official says at least 19 foreign tourists were killed as their hot air balloon crashed near the famed ancient city of Luxor. The casualties included French, British and other nationals.

The official says there was a fire and an explosion and that the balloon then plunged from the sky and crashed into sugar cane fields west of Luxor on Tuesday. Luxor is 510 kilometers (320 miles) south of Cairo.

The official spoke on condition of anonymity as he was not authorized to talk to the media.

An Associated Press reporter at the crash site says he counted eight bodies as they were put into body bags and taken away.

The metal jaws of this mechanical beast cause roofs to cave in, tear walls apart and hurl couches into the air.

There is an inescapable sadness to this business on this western spit of the Rockaway Peninsula. Four months ago, a 10-foot wall of water swept many middle-, working-class and poor neighborhoods here and left wreckage in its wake.

Vito Mustaciuolo, New York City's longtime deputy commissioner for code enforcement, has an encyclopedic knowledge of the city's many corners and stands with me on the beach. Most winter days he and his staff labor to bring heat to neglected apartment buildings; now he administers last rites to hundreds of homes marked for demolition.

His care for those who have lost homes does not go unappreciated.

"You may have to be Italian to understand this, but one older lady asked to be there when we tore it down," Mr. Mustaciuolo said. "She said it was like being at the funeral of a loved one."

Hurricane Sandy swirled toward its demise over the North Atlantic in October, but New York City and the region still reckons with wrecked lives, the many billions of dollars needed for cleanup and the challenge posed by our globally warmed world. City officials have embarked on the journey, step by uncertain step, with their eyes fixed on keeping residents in place. They guard against letting a rebuilt shoreline turn into a sandbox for the wealthy.

"Our first priority is to build back," said Brad Gair, who directs the mayor's office of housing recovery operations. "We want to help working-class people reclaim their homes."

I spent several days walking the Rockaways with Mr. Gair; Mathew W. Wambua, the city's housing commissioner; and Marc Jahr, the president of the city's Housing Development Corporation, for whom I worked as a tenant organizer in East Flatbush, Brooklyn, in the early 1980s.

Theirs is a complicated task, made more difficult by a judgment day that will arrive this summer, when the federal government sets new flood standards. If a home sits in Zone A — and much of the Rockaway Peninsula in Queens; Coney Island and Red Hook in Brooklyn; and Staten Island will — homeowners' insurance rates could jump crazily, to perhaps $10,000 a year from less than $500. There is a deceptively simple way to sidestep this increase: homeowners can raise homes on stilts, and some have set out to do this. But the cost is great, extending into the hundreds of thousands of dollars for some homes.

"If you look at a house and think it will be expensive, you're right," Mr. Gair said.

Farther east, apartment towers with government subsidized rents rise like mountain ridges. Our post-hurricane reality poses troubling questions here, too.

At Dayton Towers, the chief executive, Jeff Goldstein, had installed new boilers, elevators, lobbies and laundry rooms. His tab ran into the millions of dollars. Then Hurricane Sandy blew in. Swells washed across the shore road and turned his boiler room into a briny aquarium.

Mr. Goldstein's men restored electricity and heat within two weeks. And now? Commissioner Wambua stood in the well of Dayton Towers, yelling against the roar of the boilers. "Where do you put these?" he asked. "On the roof?"

You could encapsulate the boilers, making the basement watertight, much as a battleship safeguards its engine room, but the cost is terrific.

For many decades, the federal government rebuilt Southern cities lashed by storms. Now Congressional Republicans want to change course. Talk of storms intensified by global warming sounds suspiciously like science; they insist that New York and New Jersey not use a lot of federal money to armor their coastlines.

New York has traveled this road alone before. In the early 2000s, a developer built Arverne by the Sea, a middle-income housing development in the Rockaways.

City officials told him to take account of rising seas levels. So he trucked in landfill, raising the entire development above flood level. He buried electrical lines and put in catch basins, dunes and black pines. In late October, this neighborhood was one of the few in the area that did not flood.

The trick is to extend that sleight of hand to miles and miles of coastline, and so preserve a necklace of neighborhoods.

As Mr. Mustaciuolo walked amid houses wrecked and smashed, he said: "This is not just a bunch of houses. It's histories, it's family roots."

Which is another way of saying it's New York, and worth saving.

And that, she testified on Monday, was only the beginning.

The wife, Kathleen Mangan-Valle, said that when she later delved into her husband's electronic chat history, she found he had been communicating with others about plans to torture and kill women, including herself.

"I was going to be tied up by my feet and my throat slit, and they would have fun watching the blood gush out of me," she said, sobbing repeatedly through her afternoon on the witness stand.

The officer, Gilberto Valle, has been charged with plotting on the Internet to kidnap, rape, kill and cannibalize female victims. His wife was the first witness in the trial, which began on Monday in Federal District Court in Manhattan.

She testified that she uncovered evidence of her husband's desires to rape, maim, torture and kill women, including some of her friends.

When someone participating in the chat suggested to her husband that if she cried, "don't listen to her, don't give her mercy," she testified, "Gil just said, 'It's O.K., we will just gag her.' "

Officer Valle, 28, also wept visibly during his wife's testimony in a day of high emotion at the trial, which attracted a full gallery of observers, some no doubt drawn by the bizarre and lurid charges against the officer.

But at its core, the case rests on a tantalizing, yet basic, question: When does a fantasized crime become an actual crime?

There is no evidence that any of the women that Officer Valle was accused of plotting to kill were kidnapped or harmed.

The trial's opening arguments underscored that theme. A federal prosecutor, Randall W. Jackson, told jurors that the officer had been plotting real crimes to kill actual victims, while Officer Valle's lawyer, Julia L. Gatto, contended that he had merely been living out deviant fantasies in Internet chat rooms, with no intention of carrying them out.

One outside expert, Joseph V. DeMarco, an Internet lawyer and former head of the cybercrime unit in the United States attorney's office in Manhattan, said in a recent interview that beyond its sensationalism, the Valle case highlighted the fact that there were "dark corners" of the Internet "where a whole range of illegal and immoral conduct takes place, and the general public has only a vague and fleeting knowledge that these places exist."

He noted that the Internet, as a medium of expression and communication, also made it possible for people with interests as benign as stamp collecting or as grisly as cannibalism to find and validate one another in community forums.

"If you were someone mildly interested in cannibalism 30 years ago, it was really hard to find someone in real space to find common cause with," Mr. DeMarco noted. "Whereas online, it's much easier to find those people, and I think when you have these communities forming, validating each other, encouraging each other, it's not far-fetched to think that some people in that community who otherwise might not be pushed beyond certain lines might be."

It was clear that the prosecutors, in their opening statement and through Ms. Mangan-Valle's testimony, were seeking to bring as much realism to the courtroom as possible.

Ms. Mangan-Valle, who had taught with Teach for America and went on to become a teacher in East Harlem and in the Bronx, indicated that she had been so afraid for herself and their infant daughter that she flew to stay with her parents, who live in Nevada. She said she contacted the Federal Bureau of Investigation, gave a statement and granted the bureau access to her laptop and another computer in their home.

Mr. Jackson, the assistant United States attorney, repeatedly used the word "real" as he described the evidence in the case, like the online communications between Officer Valle and his co-conspirators.

"You are going to see in these conversations that Mr. Valle is engaging in detailed strategic discussions about real women that he has identified," Mr. Jackson said. He cited "one conversation where Mr. Valle discusses a specific real woman, a specific real woman that he knew, and discussing the logistics of fitting her into an oven."

He said Officer Valle had also been charged with illegally accessing a law enforcement database to gain information about some of the women he was "explicitly targeting."

Ms. Gatto, Officer Valle's lawyer, said in her opening statement that if the jurors had been scared by what the prosecution had described, "who could blame you?" The allegations were shocking and gruesome, she said, "the stuff that horror movies are made of.

"They share something else in common with horror movies," she added. "It's pure fiction. It's pretend. It's scary make-believe."

Ms. Gatto suggested that the stakes for Officer Valle, who has been charged with conspiracy to commit kidnapping, a charge that carries a maximum sentence of life in prison, went far beyond his case. She said cases like his test "bedrock principles, the freedom to think, the freedom to say, the freedom to write even the darkest thoughts from our human imagination."

Early on Monday, prosecutors told the judge, Paul G. Gardephe, that they would not seek to introduce data related to Officer Valle's cellphone calls to show that he was in the vicinity of certain potential victims — evidence the defense had sharply disputed.

In addition to her testimony about discovering her husband's communications about killing her, Ms. Mangan-Valle, 27, also described his chats with others about harming women they knew. Two were supposed to be "raped in front of each other to heighten" their fears, she said. Another was to be burned alive, she said. There was also talk about putting women on a spit, and cooking them for 30-minute shifts, so they could be tortured longer. She also testified that at one point she used software to track her husband's Web activities.

Ms Gatto, in cross-examining Ms. Mangan-Valle, asked why she had not been willing to talk with the defense before trial. "You represent the man who wants to kill me," Ms. Mangan-Valle replied. "No, I didn't want to talk to you," she added, breaking into tears.

JERUSALEM (AP) — Israeli police say a rocket has been fired from the Gaza Strip into Israel. A police spokesman says there was damage to a road but no injuries.

It's the first such rocket from the Palestinian territory to land in Israel since Israeli-Gaza fighting last November.

Police spokesman Micky Rosenfeld says the remains of a rocket were found on Tuesday near the city of Ashkelon, in southern Israel.

There have been protests throughout the West Bank in recent days in support of Palestinians held in Israeli jails. This weekend, one Palestinian prisoner died under disputed circumstances, prompting more protests.

A statement from the Palestinian president's office says President Mahmoud Abbas has instructed Palestinian security officials to preserve order in the West Bank, but he blames Israel for the violence.

His death was confirmed by Susan A. Wills, an assistant at the Geisel School of Medicine at Dartmouth College, which has an institute named after Dr. Koop. In 1981, Dr. Koop had never served in public office when President Ronald Reagan appointed him surgeon general of the United States. By the time he stepped down in 1989, he had become a household name, a rare distinction for a public health administrator.

Dr. Koop issued emphatic warnings about the dangers of smoking, and he almost single-handedly pushed the government into taking a more aggressive stand against AIDS. And despite his steadfast moral opposition to abortion, he refused to use his office as a pulpit from which to preach against it.

These stands led many liberals who had bitterly opposed his nomination to praise him, and many conservatives who had supported his appointment to vilify him. Conservative politicians representing tobacco-growing states were among his harshest critics, and many Americans, for moral or religious reasons, were upset by his public programs to fight AIDS and felt betrayed by his relative silence on abortion.

As much as anyone, it was Dr. Koop who took the lead in trying to wean Americans off smoking, and he did so in imposing fashion. At a sturdy 6-foot-1, with his bushy gray biblical beard, Dr. Koop would appear before television cameras in the gold-braided dark-blue uniform of a vice admiral — the surgeon general's official uniform, which he revived — and sternly warn of the terrible consequences of smoking.

"Smoking kills 300,000 Americans a year," he said in one talk. "Smokers are 10 times more likely to develop lung cancer than nonsmokers, two times more likely to develop heart disease. Smoking a pack a day takes six years off a person's life."

When Dr. Koop took office, 33 percent of Americans smoked; when he left, the percentage had dropped to 26. By 1987, 40 states had restricted smoking in public places, 33 had prohibited it on public conveyances and 17 had banned it in offices and other work sites. More than 800 local antismoking ordinances had been passed, and the federal government had restricted smoking in 6,800 federal buildings. Antismoking campaigns by private groups like the American Lung Association and the American Heart Association had accelerated.

Dr. Koop also played a major role in educating Americans about AIDS. Though he believed that the nation had been slow in facing the crisis, he extolled its efforts once it did, particularly in identifying H.I.V., the virus that causes the disease, and developing a blood test to detect it.

Where he failed, in his own view, was to interest either Reagan or his successor as president, George Bush, in making health care available to more Americans.

Dr. Koop was completing a successful career as a pioneer in pediatric surgery when he was nominated for surgeon general, having caught the attention of conservatives with a series of seminars, films and books in collaboration with the theologian Francis Schaeffer that expressed anti-abortion views.

At his confirmation hearings, Senate liberals mounted a fierce fight against him. Senator Edward M. Kennedy, Democrat of Massachusetts, said Dr. Koop, in denying a right to abortion, adhered to a "cruel, outdated and patronizing stereotype of women." Women's rights organizations, public health groups, medical associations and others lobbied against his appointment. An editorial in The New York Times called him "Dr. Unqualified."

But after months of testimony and delay, he was confirmed by a vote of 68 to 24, garnering more support than many had expected. Some senators who had been hesitant to support him said he had convinced them of his integrity.

Dr. Koop himself said he had taken a principled approach to the nomination. As he and his wife, Elizabeth, had driven to Washington for the confirmation hearings, he recalled telling her, "If I ever have to say anything I don't believe or feel shouldn't be said, we'll go home."

An Only Child in Brooklyn

Charles Everett Koop was born on Oct. 14, 1916, in Brooklyn, and grew up in a three-story brick house in South Brooklyn surrounded by relatives; his paternal grandparents lived on the third floor, and his maternal grandparents as well as uncles, aunts and cousins lived on the same street. He was the only child of John Everett Koop, a banker and descendant of 17th-century Dutch settlers of New York, and the former Helen Apel.

Dr. Koop traced his interest in medicine to watching his family's doctors at work as a child. To develop the manual dexterity of a surgeon, he practiced tying knots and cutting pictures out of magazines with each hand. At 14 he sneaked into an operating theater at Columbia University's medical college, and he operated on rabbits, rats and stray cats in his basement after his mother had administered anesthesia. By his account, not one of the animals died.

While attending high school at the private Flatbush School, he worked as a summer volunteer in hospitals near his family's vacation home in Port Washington on Long Island. He then attended Dartmouth College and, after graduating, entered Cornell University Medical College in Manhattan and married Elizabeth Flanagan of New Britain, Conn., a Vassar student.

He completed his residency at the University of Pennsylvania Hospital, where he acquired a reputation for boldness. Afterward, his surgery professor, Dr. I. S. Ravdin, offered him a job as surgeon in chief of Children's Hospital in Philadelphia, a rare offer for someone so young.

Dr. Koop held that position until the Reagan administration recruited him 35 years later. By then he had become renowned in medicine as an innovator in surgery on infants.

Dr. Koop and his colleagues performed thousands of operations to correct birth defects in premature babies or other newborns; 475 operations alone were on those with esophageal atresia, a condition, previously fatal, in which the esophagus and the stomach are not connected.

In one case, after cutting open the side of a baby's chest to find an entire section of the esophagus missing, he built, on the spot, a new link out of tissue from the baby's colon. It became standard procedure for repairing such a defect. He also did groundbreaking work in separating conjoined twins.

Faith and Principle

His experience in correcting birth defects compelled him to thrust himself into the middle of a controversy in the early 1980s over the rights of infants with congenital defects to receive medical care. In two cases involving infants, identified as Baby Doe and Baby Jane Doe, those who favored government intervention to save a disabled child were pitted against liberals, libertarians and medical groups who argued that parents had the right to withhold treatment from a child who was severely impaired.

Though courts sided with the parents, Dr. Koop spoke out against the parents' decisions in both cases, saying that the medical and legal establishments had a duty to protect citizens against neglect and discrimination, no matter their age, and that a government's authority to override the rights of parents had been established in truancy law, child abuse and immunization laws. (Baby Doe died while the case was being appealed to the United States Supreme Court; Baby Jane Doe survived, though a delay in treatment was believed to have contributed to her severe retardation.)

Dr. Koop often said that his Presbyterian faith had helped him and his wife cope with the death of his 19-year-old son, David, who was killed in 1968 when a cliff gave way while he was climbing in New Hampshire. Dr. Koop and his wife wrote about the loss of a child in "Sometimes Mountains Move," published in 1974.

Dr. Koop's religion was also central to his opposition to abortion, which he considered a violation of divine principle. But once in public office, he said, he found it necessary to declare — to the disappointment of the White House — that evidence did not support the contention that abortions were essentially unsafe. In taking that position, he later said, he was being naïve. He had failed to realize that the Reagan administration expected him to zealously oppose abortion, he wrote in his 1991 autobiography, "Koop: The Memoirs of America's Family Doctor." And in an interview for this obituary in 1996, he said he had declined to speak out on abortion because he thought his job was to deal with factual health issues like the hazards of smoking, and not to express opinions on moral issues.

Abortion presented little health hazard to women, he said, so it was a moral and religious matter, not a health issue.

Taking on Big Tobacco

Dr. Koop said he had begun campaigning against smoking after studying the research into its link to cancer, heart disease, stroke and other diseases. He was "dumbfounded," he said, "and then plainly furious at the tobacco industry for attempting to obfuscate and trivialize this extraordinarily important public information."

In taking on the tobacco lobby, he was also taking on powerful politicians from tobacco-growing states. After Dr. Koop accused the industry of directing advertising at children and threatening human lives, Gov. Jim Hunt of North Carolina, a Democrat, called for his impeachment, and Senator Jesse Helms, Republican of North Carolina, tried in vain to have Congress investigate him.

Dr. Koop came to believe that the Reagan administration itself offered only lukewarm support for the antismoking public-education campaign "A Smoke-Free Society by the Year 2000." Feeling stymied, he said, he asked himself, "What if I called on America itself?" So he embarked on a national speaking tour in 1984, often wearing the uniform of his office. The uniform, he said, was intended to help restore his diminishing authority as the surgeon general and director of the Public Health Service.

In 1986, a surgeon general's report expanded the alarm about smoking, stating that secondhand smoke had also been conclusively proved to cause cancer. Over the next year, federal, state and local governments and private businesses began to restrict smoking in public and quasi-public places like restaurants, airports and workplaces. (In 2004 he joined with three other former surgeons general to offer a plan to cut cigarette smoking in part with a $2-a-pack tax increase.)

AIDS had just been discovered when Dr. Koop was awaiting confirmation in 1981. But within weeks, with 108 cases reported in the United States and 43 deaths, "I knew we were in big trouble," he said. He said he realized later that the Reagan administration had been slow to address the disease because the election had brought to power people who were antithetical to gay people, then thought to be its only victims.

As the epidemic worsened, reaching drug addicts infected with contaminated needles and hemophiliacs who had received a contaminated blood-clotting factor, Reagan, in 1986, asked Dr. Koop to prepare a special report. Dr. Koop proceeded cautiously, knowing the report would be unpopular with many in the administration, with conservatives in Congress and with church groups opposed to homosexuality. He wrote 17 drafts.

A Public Profile

With its release, he was attacked as advocating that third graders be taught about sodomy and that 8-year-olds be given condoms. What the report said was that the best protection against AIDS was abstinence and monogamy, but that for those who practiced neither, condoms were a necessary precaution.

White House aides tried to get him to delete the reference to condoms, but he refused to alter the report or make it more morally judgmental. He prevailed, and the government eventually printed more than 20 million copies of the report.

Dr. Koop later wrote that "political meddlers in the White House" had complicated his work on the disease, and that "at least a dozen times I pleaded with my critics in the White House to let me have a meeting with President Reagan" on AIDS in the mid-1980s. Too many people, he said, "placed conservative ideology far above saving human lives."

He added: "Our first public health priority, to stop the further transmission of the AIDS virus, became needlessly mired in the homosexual politics of the early 1980s. We lost a great deal of precious time because of this, and I suspect we lost some lives as well."

Dr. Koop had no success in pushing the Reagan administration to take action on delivering health care to Americans who could not afford it. He announced his resignation after Mr. Bush was elected president in 1988 and did not name him secretary of health and human services, as Dr. Koop had hoped.

Dr. Koop's first wife died in 2007; he is survived by their three children, Allen, Norman and Elizabeth Thompson; eight grandchildren; and his second wife, Cora Hogue, whom he married in 2010.

In 1992 Dr. Koop founded the Koop Foundation in Hanover, N.H., to help strengthen humanitarian values among doctors. In 1995, nearing his 80th birthday, he became chief executive of a Time-Warner division, Time Life Medical, to produce videos for sale in pharmacies. Dr. Koop appeared in the videos, tailored to patients with newly diagnosed diseases, to explain the ailment, alternative treatments and anticipated outcomes.

In 1997 he founded DrKoop.com, a popular medical information Web site whose critics said blurred the line between objective information and advertising and promotional content. The site was valued at more than $1 billion before it went bankrupt in the collapse of the Internet bubble.

Dr. Koop also came under criticism in 1999 when a panel of scientists he led investigated claims that certain chemicals used to make plastics more flexible — in hospital tubes and some children's toys, for example — were dangerous. The panel determined that they were safe, a finding disputed by Health Care Without Harm, an international coalition of health workers, advocacy groups and environmentalists.

Dr. Koop maintained a public profile well into his later years. In January 2010, he appeared in an advertisement opposing the Democratic health care proposal then being negotiated in Congress, saying it threatened to ration health care for older people, an assertion that drew criticism as misleading.

When he stepped down as surgeon general, however, Dr. Koop had won over many of his original detractors.

"The skeptics and cynics, this page included, were wrong to fear that Surgeon General C. Everett Koop would use his office only as a pulpit for his anti-abortion views," an editorial in The New York Times said in 1989, as he was leaving office. "Throughout he has put medical integrity above personal value judgments and has been, indeed, the nation's First Doctor."

She started with free food and new smartphones for every employee, borrowing from the playbook of Google, her employer until last year. Now, though, Yahoo has made a surprise move: abolishing its work-at-home policy and ordering everyone to work in the office.

A memo explaining the policy change, from the company's human resources department, says face-to-face interaction among employees fosters a more collaborative culture — a hallmark of Google's approach to its business.

In trying to get back on track, Yahoo is taking on one of the country's biggest workplace issues: whether the ability to work from home, and other flexible arrangements, leads to greater productivity or inhibits innovation and collaboration. Across the country, companies like Aetna, Booz Allen Hamilton and Zappos.com are confronting these trade-offs as they compete to attract and retain the best employees.

Bank of America, for example, which had a popular program for working remotely, decided late last year to require employees in certain roles to come back to the office.

Employees, especially younger ones, expect to be able to work remotely, analysts say. And over all the trend is toward greater workplace flexibility.

Still, said John Challenger, chief executive of Challenger Gray & Christmas, an outplacement and executive coaching firm, "A lot of companies are afraid to let their workers work from home some of the time or all of the time because they're afraid they'll lose control."

Studies show that people who work at home are significantly more productive but less innovative, said John Sullivan, a professor of management at San Francisco State University who runs a human resource advisory firm.

"If you want innovation, then you need interaction," he said. "If you want productivity, then you want people working from home."

Reflecting these tensions, Yahoo's policy change has unleashed a storm of criticism from advocates for workplace flexibility who say it is a retrograde approach, particularly for those who care for young children or aging parents outside of work. Their dismay is heightened by the fact that they hoped Ms. Mayer, who became chief executive at 37 while pregnant with her first child, would make the business world more hospitable for working parents.

"The irony is that she has broken the glass ceiling, but seems unwilling for other women to lead a balanced life in which they care for their families and still concentrate on developing their skills and career," said Ruth Rosen, a professor emerita of women's history at the University of California.

But not only women take advantage of workplace flexibility policies. According to the Bureau of Labor Statistics, nearly as many men telecommute.

The bureau says 24 percent of employed Americans report working from home at least some hours each week. And 63 percent of employers said last year that they allowed employees to work remotely, up from 34 percent in 2005, according to a study by the Families and Work Institute, a nonprofit group studying the changing work force.

During the recession, the institute expected employers to demand more face time, but instead found that 12 percent increased workplace flexibility, said Ellen Galinsky, its president and co-founder. She attributed this to companies' desire to reduce real estate costs, carbon footprints and commuting times.

Technologies developed in Silicon Valley, from video chat to instant messaging, have made it possible for employees across America to work remotely. Yet like Yahoo, many tech companies believe that working in the same physical space drives innovation.

A Yahoo spokeswoman, Sara Gorman, declined to comment, saying only that the company did not publicly discuss internal matters.

The company's memo, written by Jackie Reses, director of human resources at Yahoo, and published on All Things D, a blog on digital issues, said: "Some of the best decisions and insights come from hallway and cafeteria discussions, meeting new people and impromptu team meetings. Speed and quality are often sacrificed when we work from home."

In part, the memo looks like an effort to bring a Google spirit to Yahoo, said Colin Gillis, an analyst at BGC Partners who covers both companies.

"Marissa's trying to increase the energy and output and change the culture of the company," he said. "She brings all the Google lessons to the table, and Google is very focused on having your life revolve around their campus so you can spend a significantly larger chunk of time at work."

Still, Google, as well as Facebook, does allow people to work remotely on a case-by-case basis. But both companies also strongly stress in-person collaboration.

Standard Silicon Valley perks like cafeterias with free food, shuttle buses, gyms, ice cream parlors and dry cleaners not only make employees' lives easier, but keep them on campus during the day and promote contact with other employees. Nearly all tech companies have desks packed tightly together without walls and communal work areas with sofas and beanbags.

Zappos, the e-commerce company owned by Amazon.com, previously allowed some customer service agents to work from home, but now has a rule against working remotely. The company locks all office doors except one so employees are forced to run into more people on the way out, and budgets fewer than 100 square feet per employee, versus the standard 120 square feet or more.

"It's to maximize those serendipitous encounters," said Zach Ware, who oversees campus development at the company. "The success of our company is built on our culture, and our perspective is you can't really do that on e-mail."

Some companies outside the tech industry are also re-evaluating flexible work arrangements. In addition to Bank of America, certain industries that deal with sensitive client information, like health care and finance, have more restrictions on working remotely.

Yet more companies embrace flexibility. At Aetna, 47 percent of workers telecommute, up from 9 percent in 2005. The company provides secure Internet and phone connections, locked file cabinets and shredders. During that period, the policy has saved the company $78 million in real estate costs, said Susan Millerick, an Aetna spokeswoman.

At Booz Allen, employees can work at home or sign up to work at a desk in another branch, called "hoteling." The policy has been vital to employee retention, said Christopher Carlson, a senior associate in human resources at Booz Allen. He works from his home in Florida, where he moved from the Washington, D.C., region to care for his aging parents.

"It allows me to integrate my work and life and be successful at both," Mr. Carlson said. "And I spend less money on gas."