After the Republican landslide in last month's congressional elections, Clinton clearly had little room, or inclination, to accommodate another provocative remark from the nation's chief doctor.
"Dr. Elders' public statements reflecting differences with administration policy and my own convictions have made it necessary for her to tender her resignation," Clinton said in a statement issued by the White House.
Elders yesterday sent a letter to Health and Human Services Secretary Donna E. Shalala, saying she intended to resign at year's end.
"I feel this halfway point is a good time for me to go," she wrote. ''While some administration officials and I have some honest differences over the issues, President Clinton and I maintain our strong mutual respect for each other - a respect and friendship that has endured for many years. I look forward to returning with my family to Arkansas."
Incoming House Speaker Newt Gingrich (R., Ga.) said: "It's good for the country and good for the President that she's departed." Gingrich had attacked her earlier this week for suggesting the study of legalizing drugs.
"We are extremely pleased," said Tom Kilgannon of the Christian Action Network. "This woman from day one has insulted traditional values and insulted the Christian community. She was a symbol of extremely liberal policies of the Clinton administration, and more often then not she was an embarrassment."
Elders was asked at the United Nations World AIDS Day on Dec. 1 about the prospect of promoting masturbation as a way to discourage school-age children
from riskier sexual activity.
"I think that is something that is a part of human sexuality, and it's a part of something that perhaps should be taught," she said in front of 200 people. "But we've not even taught our children the very basics. And I feel that we have tried ignorance for a very long time, and it's time we try education."
In a telephone interview with the Associated Press from her home outside Washington yesterday, Elders said she had intended to relate her belief that students should be taught that masturbation is a natural part of human sexuality - not that youths should be taught how to masturbate.
"Heavens, no. That's not what I was trying to say," she said. "You can't teach people how to do that, just like you can't teach them how to have sex."
The White House learned about Elders' comments late Thursday, confirmed them yesterday morning and, according to the White House, Clinton said: "She must resign."
"The President feels that is wrong, feels that's not what schools are for, and it is not what the surgeon general should say," White House chief of staff Leon E. Panetta told reporters in his office.
Panetta did not say how the White House learned of the comments, but U.S. News & World Report magazine is publishing a profile of Elders in next week's issue, containing the controversial quotation.
Panetta said he, Clinton and Shalala had warned Elders not to make statements that clashed with the President's position.
"This is just one too many," Panetta said.
Panetta said Clinton spoke with Elders by phone yesterday afternoon after his speech at a Latin American summit in Miami and talked to her directly about resignation.
"If she had not resigned, she would have been terminated," Panetta said.
Elders is the latest in a string of Arkansans to come to grief since coming to Washington with Clinton less than two years ago.
The others include: Associate Attorney General Webster L. Hubbell, who pleaded guilty this week to two felonies in connection with overbilling at a Little Rock law firm; David Watkins, the White House administrator who hopped a presidential helicopter for a golf outing; and White House lawyer William Kennedy, a former law partner of Hillary Rodham Clinton.
Elders, a former sharecropper's daughter and pediatrician, has been controversial since confirmation hearings that focused on her views for sex education for just about all schoolchildren. During the hearings, one senator cautioned her that she would need to soften her "bedside manner" to function effectively in the job.
Since then, she suggested that the country study whether to legalize drugs and attacked the Catholic Church as having "a love affair with the fetus."
When she told a group of gays and lesbians in June that they must help save the children from "the un-Christian religious right," 87 GOP members of Congress demanded her resignation. The administration responded by saying she did not represent the views of the President.
Last summer, Elders was struck by personal tragedy: Her son Kevin, 28, was sentenced to 10 years in prison for selling cocaine to a police informant. She indicated that she felt he had been set up because of her high profile and controversial stands.
With all the controversy and trauma, even her strongest admirers began to wonder how long she would stay in the job. But in October, at a conference sponsored by the Congressional Black Caucus, she said she was willing to stay.
"I don't mind being a lightning rod, as long as you are the thunder behind me," said Elders, who ran the Arkansas Health Department when Clinton was governor.
Liberals reacted with outrage to Elders' forced resignation.
"Clinton is essentially throwing Joycelyn Elders to the wolves, just like he did Lani Guinier," said David Bositis, senior analyst for the Joint Center for Political and Economic Studies, a think tank that focuses on issues related to blacks.
"Elders represented someone who was not ingratiated to the powers to be and was not afraid to speak out against them," he added.
Patricia Ireland, president of the National Organization for Women, said: ''Joycelyn Elders was a lightning rod because she spoke the truth: that the religious right wants sex education without educating about sex. It just infuriates me. This says to all of the women's-rights advocates in the administration: Don't talk out loud. It won't be tolerated."
Bositis said that the move would hurt Clinton politically and that he was inviting a challenge from the left, perhaps from Jesse Jackson.
"His record with the minority community is not as good as he thinks it is," he said. "And he is quite mistaken if he thinks there is absolutely any way he will be accepted by people who want a moderate or conservative president."
But a black conservative, Bob Woodson, founder of the National Center for Neighborhood Enterprises, said "good riddance."
"She's just exhausted her nine lives," he said. "From the very beginning, she has embarrassed this President and done a lot of damage to his credibility. And the Republicans were going to make her the poster child of 1996.
"Her timing has always been bad. But to do this at the time he is trying to position himself in the center is outrageous."
Some said Elders' job security slipped away with last month's midterm election results, in which Republicans gained control of both houses of Congress for the first time since 1954.
"The election three weeks ago is still claiming Democratic victims," said Gary Bauer, president of the conservative Family Research Council.
"It is not a coincidence that Joycelyn Elders' departure from the Clinton administration comes just before a conservative GOP majority prepares to take the lead on family issues."
The Planned Parenthood-endorsed National Guidelines for Sexuality Education, published by the Sex Information and Education Council of the United States, says masturbation should be taught to children, ages 5 to 8.
That approach says that "touching and rubbing one's own genitals is called masturbation" and that it "should be done in a private place."
The guidelines suggest that for older children, ages 12 to 15, ''masturbation . . . is one way a person can enjoy and express their sexuality without risking pregnancy or . . . disease."