Photo Gallery: A Trip to Auschwitz

Foto: Maria Feck/ DER SPIEGEL

Students of Death Euthanasia Doctors Seek Existential Answers at Auschwitz

A group of Belgium's leading practitioners of euthanasia recently visited the Auschwitz concentration camp memorial to learn more about death and humanity. The trip proved to be just as controversial for the doctors as it did insightful.

Wim Distelmans is responsible for the deaths of hundreds, if not thousands of people. He's a man who scrupulously studies his field of work. In London he visited the world's first modern hospice, and he toured the first home for the dying in Scotland. He has even flown as far afield as Moscow to gain a better understanding of how we deal with death and dying. Now, his next study tour will take him to Poland. Distelmans is a palliative doctor from Brussels -- a physician who helps people die. He's nervous. He didn't sleep well and he was up early. The prospect of visiting Auschwitz makes him feel uneasy.

On this October morning, Distelmans, 62, is standing at a gate at the Brussels Airport. He's a man with ice-blue eyes and gray hair that is slightly wavy at the neck. Distelmans is wearing a brown leather jacket over a T-shirt, hiking pants and a blue-and-white striped linen scarf -- and he's taller than the people around him -- and quieter. A few hours ago, at five in the morning, he received a call. A friend who is a concentration camp survivor, and had been planning to accompany the group to Auschwitz as a tour guide, has called off her trip because she has come down with a cold.

Distelmans gazes at the people flocking around him. "Good morning, how are you?" he says greeting them, as he slaps the men on the shoulder and kisses the women on the cheek. He says he isn't sure whether the tour guide's cancellation has anything to do with the destination of their five-day study tour.

Some 70 people gradually gather around Distelmans. The group consists of doctors, psychologists and nurses from Belgium, most of whom work in the area of euthanasia. One of them is Eric Vandevelde, who during the course of his career has killed 20 people at their own request even as he helps women give birth every day. He's accompanied by his wife Colette, who was instrumental in introducing Belgium's euthanasia law 12 years ago. Manu Keirse, a psychologist, is also on hand. He's the author of 35 books, nearly all of which are on the topic of mourning. There's also Bea Verbeeck, a psychiatrist who is currently examining a request by a manic depressive man who gambles away tousands during his manic phases. Distelmans, who is the chairman of the Belgian government's Euthanasia Commission, has invited all of them on a trip to Poland.

Death with Dignity

In Auschwitz he intends to reflect with them on the meaning of "death with dignity". That's also the title of the tour, which is printed on the program booklet. It has to do with existential questions: self-determination, fear and freedom -- and what these things mean to us today. And it concerns how far we go, should go, and should be allowed to go.

But the group is not limited to euthanasia specialists. A Belgian journalist is also standing at the gate. "I'm traveling as far as Birkenau, and when I have enough material, I'll go back home," he says. A tour operator accompanying the group says, "I normally do football trips." There's also a homeopath who says: "A well-balanced individual has no need for euthanasia." Some of the medical professionals have taken along their wives, who are looking forward to seeing the picturesque medieval city of Krakow. A Jewish photographer named Guy Kleinblatt is also there. Members of his family died in Auschwitz and he is visiting the site for the first time. What all of these people have in common is that they support euthanasia and a liberal society.

They are following Distelmans to Auschwitz, they say, to learn more respect for their fellow human beings. In Auschwitz they intend to find out why the right of the individual to decide over his own life is inalienable -- and why people must be absolutely free to make their own decisions in this respect. Auschwitz, they say, is the antithesis of everything that they hope to achieve, and they are seeking to reflect there upon what it means to kill out of humility and love.

Protesting 'Dr. Death'

There were protests in the run-up to this trip. The British Daily Mail Online dubbed Distelmans as "Dr. Death" and described his trip to Auschwitz as tasteless. Meanwhile, Belgian journalists have also picked up on the debate using the Dutch translation for the same moniker. In the northern Belgian city of Antwerp, ultraorthodox Jews staged protests to voice their outrage at Distelmans referring to Auschwitz in his travel itinerary as an "inspiring venue." They called him a "professional killer." Distelmans received an email from a German-speaking scholar that contained just one word: "murderer." After the trip was over, the deputy director of the Auschwitz memorial wrote an email in response to the protests in which he said: "We feel that the attempt to link the history of Auschwitz with the current debate about euthanasia is inappropriate."

There is not a cloud in the sky when the tour group arrives at the airport in Krakow, where a white double-decker bus awaits them. Distelmans steps out of the door of the arrival terminal, pulling a suitcase behind him. He is still somewhat subdued as he takes a seat on the bus next to his girlfriend, Sonja Snacken, a criminologist researching the degradation of people in captivity. Distelmans gazes out the window. As the bus pulls away from the curb, his girlfriend briefly places her hand on his.

The bus passes by gray, low-lying houses with crumbling plaster, a fast food stand where a corpulent man sells sausages, the Vistula River, a castle on a hill, a flock of pigeons under a tree, and numerous churches. Krakow is a city that attracts millions of tourists every year. They circulate in small, open electric vehicles emblazoned with advertising messages in red paint like "Ghetto," "Schindler's Factory" and "Last Minute Auschwitz Tour." When the Germans seized Krakow during World War II, they initially herded the Jews into a quarter of the city and sealed off the entrances with barbed wire. "Welcome," the tour guide says to the Belgians. He invites them to enter the Scandale Royal restaurant.

The restaurant is decked out in purple plush, with gilded mirrors hanging on the walls. The waitresses in miniskirts serve fish soup, and the sound of clattering dishes echoes from the kitchen. Distelmans sits down, without a word of welcome to his guests, without giving a speech. A woman from the group says: "Poland is a devoutly Catholic country. Perhaps we are not welcome." She glances at her neighbor and wonders if there will be more protests over the coming days. Distelmans eats.

He is familiar with all the allegations, and he senses the mistrust that took hold after he announced this trip to Auschwitz. The world is questioning his purpose here. Is a physician who practices euthanasia allowed to visit this place? Is he allowed to gaze into the abyss to assure himself of the moral fortitude of his actions? Is it possible to study one individual's suffering to ease that of another? Is that cynical? Absurd? Isn't it analogous to traveling to the North Pole to learn something about heat? Or staring at the color black to recognize the white canvas beneath it?

Two weeks earlier, Distelmans was walking around his assisted dying center near Brussels, one of the places in Belgium where people can come to find out more about euthanasia. Patients spend their time here, playing cards or simply sitting for hours in a chair and waiting for nothing. If someone says that he is going to die soon, and he knows the date and the time of day, the others throw a party for him with sparkling wine, chips and his favorite music.

Euthanasia in Belgium

Distelmans was relaxed on that day in Brussels -- and proud of his work. He talked about his favorite films by German director Wim Wenders, and introduced the asthmatic office dog, a pug. Then he rattled off a few facts about his country: Since 2002 it has been legal in Belgium for a physician to kill a terminally ill patient who wishes to die. Last year, 1,807 people received euthanasia, which amounts to 2 percent of all fatalities in the country. For the past few months, terminally ill children have also been able to apply, regardless of how old they are. Anyone who is terminally ill, and whose suffering has become unbearable, may receive assistance in dying. What is unbearable? "That's up to the patient to decide," Distelmans responded. He talked about Germany, and said that he felt sorry for every patient who has no money to travel to Switzerland, where assisted suicide is legal. His heart goes out to everyone who has to die alone.

In Belgium a person who wants to die with someone else's assistance must be of a sound state of mind. He has to write down his wish and express it on a number of occasions. Then an attending physician has to establish whether the patient is terminally ill, and explain what treatments are still possible. The law prescribes that the doctor and the patient have to come to the conclusion that there is no other viable solution. If the patient were going to die in the immediate future anyway, only two physicians are required to decide on his wish. If no prognosis can be made about his life expectancy, three physicians need to be consulted.

Too Quick To Say Yes to Suicide?

Distelmans trains these physicians who help others die. He developed the system of LevensEinde InformatieForum (LEIF) doctors, who provide consulting and support to general practitioners across Belgium. LEIF doctors distribute euthanasia application forms to pharmacies and libraries. They hold the hands of people who are so far gone that all they can do is vomit. Their patients are sometimes still capable of walking, eating, drinking and speaking, but they can no longer deal with the fear.

On this particular day in Brussels, Distelmans attends a farewell party for Steve, a wheelchair-bound young man who has a daughter -- and is ready to leave this world. Distelmans' critics accuse him of being too quick to say yes. For instance, when he agreed to euthanize a man who was suffering from a botched sex change operation. Or when he helped two 43-year-old twin brothers, both born deaf, put an end to their lives after they found out that they might also go blind. A young man is suing Distelmans because the doctor euthanized his depressed mother upon her request.

Speaking in his office in Belgium before the trip to Auschwitz, Distelmans said: "We are the first generation that can artificially determine both the beginning and the end of life. People are getting older and machines allow them to live forever. We have to take responsibility for the fact that not every individual is willing to take this path." He says he opposes a dictatorship by machines.

'Good Death'

Back in Krakow, Distelmans and the physicians have finished their desert, and are slowly filing out of the restaurant. The next activity is a guided tour of the city, and they have received nametags. Distelmans pins his nametag to his T-shirt, places his scarf on top of it, and pulls his jacket over his scarf. "I don't know if I have any opponents here," he says. Before the trip, a picture of him appeared on Google. Someone had doctored the image and put an SS uniform over his sweater.

That evening, the group checks into the Hilton Garden Inn Hotel. In the marble lobby there is a sign that reads "Dying with Dignity." It is the evening before the visit to Auschwitz. "This way," says the tour guide, as he directs the Belgians toward a conference room. The idea is to find the right frame of mind for Auschwitz. Distelmans steps up to the podium. "We are here today to allow ourselves to reflect on dying with dignity," he says. "There were protests before our trip. But there is no better place than Auschwitz to ponder the meaning of dignity. When we deal with euthanasia, we must also come to terms with its opposite. In Belgium we use euthanasia in the original sense of the word: It means 'good death.' That's the problem. We will have to explain over and over that we intend the opposite of what occurred in Auschwitz."

Everyone applauds.

His girlfriend Sonja Snacken goes to the podium. She shows pictures of Abu Ghraib, photos of executed prisoners in Iran and images of tormented Syrians who were tortured in Assad's prisons. She says: If an individual is subordinate to someone else and, at the same time, dependent upon that person, they can end up being humiliated." She tells the notorious story of the Stanford prison experiment in the US, in which students played the roles of prisoners and guards to study what psychological effects this would have. The experiment had to be called off because the guards lost control and abused the prisoners.

"What does this mean to us?", Distelmans asks. "Many of us are doctors. We have power over other people. We know everything better. We were taught to preserve life. But we have to make sure that we do not continue to treat our patients, against their wills, when they actually want to die. Nobody should assume that they have the power to judge what a life is worth. We must become the servants of our patients, and when it comes to the end, we have to accept our failure as physicians."

'Who Are We to Put Oursleves Above Others?'

Manu Keirse, a short man with glasses, gray hair and a checkered shirt, takes the microphone. The psychologist, with 40 years experience working for Belgian hospitals, has visited numerous concentration camp memorials. His presentation is titled, "What Auschwitz Has Taught Me about Caring for Terminally Ill Patients." In it, he says, "We want to examine the injustice that was committed back then and transform it into justice. In Auschwitz the Nazis made people into numbers. They gave them striped clothing, took away their names, and tattooed them with numbers. What are we doing? In our hospitals we don't speak of people, but instead refer to them by their disease: the cancer back there, the lung over there, the intestine next door." Keirse pauses for effect. "Let's not do that," he says, adding: "Who are we to put ourselves above others like that?"

The next day, it takes one and a half hours to drive from Krakow to Auschwitz. During the trip, Keirse reads a book titled "The Enlightened Heart - The Psychological Impact of a Life in Extreme Fear." It was written by a concentration camp survivor. Guy Kleinblatt, the photographer whose family was killed in Auschwitz, has closed his eyes and is resting his head on his hands. Distelmans is watching a film about Auschwitz that is being shown in the bus. Outside, the marshland rolls by.

Outside the main camp at Auschwitz, boisterous classes of schoolchildren jostle at the entrance as more buses arrive. The Belgians step out of their bus and congregate in small groups on a nearby meadow and wait for their tour to begin.

They receive headphones and pass through metal turnstiles. The man who will give them a guided tour is standing in the inner courtyard. The doctors gather around him. They follow him through the same entrance that the Jews passed through, and stop for a moment and gaze at the gate with the cynical motto "Arbeit macht frei".

They continue to the buildings made of brick, where they see an urn filled with the ashes of the dead. Behind a pane of glass is a model of a gas chamber. The poison -- hydrogen cyanide in the form of Zyklon B -- was thrown through an opening in the ceiling. They walk by huge amounts of hair, spread out in a long row. It is the hair that was cut from the women's heads after they died. People made carpets out of it. They walk by a carpet. They see piles of eyeglasses with shattered lenses. One room has a floor littered with bowls. Another room has thousands of shoes, stacked on top of each other, with laces, heels and stiff leather uppers. The footwear is covered with dust and bits of earth. There is a row of crutches and a jumble of prostheses for children's legs. Tall stacks of suitcases are inscribed with names and dates: Hana Fuchs, orphan, June 3, 1936.

Distelmans' feet are heavy, and he almost stumbles as he makes his way across the cobblestones. He has been thinking about this place for months. He wanted to understand what drives people who eradicate other people. He wanted to make industrial mass murder into something that was personally tangible. He wanted to face the monstrous, abysmal truth to understand how this differed from killing out of respect and love. But he was also afraid to cross this threshold. Now, he senses the fear that hangs over this place, and is overwhelmed to the point that he cannot put his feelings into words. He says he understands nothing.

Kleinblatt, the Jewish photographer, walks by him, searching for his great-grandfather -- some sign of his great-grandfather. He roams the long corridors of the buildings, with floors covered in straw. On the walls are photos of men and women with their names. He gazes into their faces, sees their pain. Where is his great-grandfather?

The physicians walk downstairs to a basement. They see the cells that were so small that prisoners were forced to stand, and other cells where people were locked away to starve to death. The doctors walk through a gas chamber. There is an infirmary with a chamber where SS doctors performed experiments on inmates, sterilizing men and women, and injecting phenol into prisoners' hearts. The Belgian physicians remain standing in front of this chamber for a long time, transfixed by the sight of a stethoscope and a white doctor's smock on the table.

Distelmans and Keirse, the psychologist, go outside to get some air. Keirse says that the worst part for him is that many Nazis were animal lovers. He says: "Rudolf Hess loved dogs." A woman from the group is walking behind them. She says she would like to see euthanasia laws in Belgium extended to include people who are suicidal. She also doesn't think that children with terminal illnesses should require their parents' signatures if they want to end their lives.

A Place without Hope

Distelmans and Keirse enter a bookstore at the entrance and both purchase a work by Miklós Nyiszli titled "Auschwitz: A Doctor's Eyewitness Account." Nyiszli was a prisoner in a Sonderkommando, and he worked under the notorious SS doctor Joseph Mengele. The former inmate describes how he had to boil corpses in barrels to prepare their bones, and how he once found a woman alive under a pile of corpses.

Distelmans looks at the pages of the book and says that he wants to understand.

The group drives to an international meeting center near Auschwitz for a meal, though some of the group members have no appetite. Distelmans sits on a wooden bench next to his girlfriend. Later, the doctors take a group photo in the garden under the trees. It's a bright, sunny day. The tour guide says: "We are going to start driving again now so we can be in Birkenau by sundown."

Here, in the former Auschwitz-Birkenau extermination camp, prisoners arrived by train. They had to stand in rows after they disembarked. Distelmans and his colleagues walk along the rails, while the low-lying sun bathes the premises in golden light. A railway car without windows stands on the tracks.

The complex is extensive, and bright green grass is growing on the ground. Distelmans walks by some barbed wire. He's now ready to speak. He talks about the false paternalism of doctors. A paternalistic doctor is a doctor who forces life upon an individual -- someone who always knows better, and tries to convince the patient to accept treatment, instead of merely informing him of his options. A paternalistic doctor is a power monger. Distelmans' hands move in opposite directions to demonstrate his point. The patient is the lower hand, the doctor is the upper one. Distelmans hates power. He says that as a child he attended a Jesuit school where they were awarded points if they snitched on other children.

Keirse walks up from behind. The two men have known each other for 20 years. Keirse is Catholic; Distelmans is an atheist. Keirse says that he had to sit down in front of the ruins of a gas chamber because he just couldn't go on, because this is a place without hope. Keirse goes on to say that when he counsels terminally ill patients, he always tries to encourage them to choose in favor of life. "They are so lonely in their pain. I have to give them something to look forward to: another birthday, a wedding, one last trip to the seaside, and taking another person by the hand, things like that. Otherwise the fear becomes too much to bear. You know, Distelmans," says Keirse, "otherwise, the fear becomes too much."

The doctors leave the premises. In this place they have witnessed the extreme limitation of freedom in a bid to discover what limitless freedom means. Most of the doctors, including Distelmans, say after their visit that Auschwitz has moved them, and that they can now be better, more sympathetic human beings in their interactions with patients.

In contrast to the others, though, Distelmans came to Auschwitz with an agenda: He wanted his colleagues to understand his definition of freedom -- and he hoped they would admit that there can only be freedom if people can liberate themselves from the power of others. Distelmans is a radical, and he thinks in absolute terms. He doesn't see that the freedom to decide about one's own life can be overwhelming for a patient. He doesn't see that an individual who is hesitating on the threshold between life and death might want someone who says: Don't go.

It is quiet in the bus on the drive back to Krakow. Darkness has descended and the forest casts shadows into the vehicle's headlights. A little bit earlier, while he was still standing in front of the ruins of the gas chamber, Distelmans received a phone call from a family in Belgium, asking him to put an end to the life of an incurable patient who had fallen into a coma. He told them that he could do nothing as long as the patient had not put his wishes in writing. Then he switched off his mobile phone.

Distelmans was annoyed by the family's attitude, and he noted that if this person were still conscious he would have the impression that he was disturbing his family so much that it would be better if he died. "We don't sort out people. We need the freedom to die, but this also entails the freedom not to exercise that right."

Euthanasia for a Nazi?

On the last evening in Poland, Distelmans accompanies his group to a restaurant in the old Jewish quarter of Krakow, where they are served vodka and herring. A man plays the violin and the atmosphere is good. The doctors talk about their children and vacation trips to Sweden. Later, around midnight, the conversation returns to their work. They discuss the case of a colleague in the group who asked if he is allowed to kill a Nazi. The patient in question is paralyzed on one side and is a former member of the Waffen-SS. In fact, a portrait of Hitler hangs over his sofa. The colleague refused to perform euthanasia because he doesn't feel the Nazi deserves a painless, gentle death. His neighbor at the table says: "I could have no empathy for his suffering as an individual because the guy doesn't tick the way a normal person does. If I killed him, I would feel like a murderer."

Distelmans sits nearby and says nothing.

Back at work in Belgium on Monday of the following week, he thinks back to that conversation. He is once again wearing his doctor's smock and standing in a hospital room in Brussels. Outside the window, trees drenched with rain are losing their leaves. This is where he brings his patients before he gives them a deadly injection. They can see the trees, and there is room on the broad window sill for friends to sit. Distelmans says that he often has to clear away champagne bottles here.

He looks out the window and his breath steams up the glass. Distelmans reflects for a moment on the Nazi, and then says that he would perform euthanasia if the request where commensurate with the law. He says that he would do it out of respect for the man's pain and humanity -- as an act of unconditional love.

Translated from the German by Paul Cohen
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