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Visiting Holocaust-Related Sites with Medical Students As an Aid in Teaching Medical Ethics Esteban González-López MD Phd and Rosa Ríos-Cortés MA

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Visiting Holocaust-Related Sites with Medical Students As an Aid in Teaching Medical Ethics Esteban González-López MD Phd and Rosa Ríos-Cortés MA IMAJ • VOL 18 • may 2016 FOCUS Visiting Holocaust-Related Sites with Medical Students as an Aid in Teaching Medical Ethics Esteban González-López MD PhD and Rosa Ríos-Cortés MA Department of Medicine and School of Medicine, Autónoma University of Madrid, Madrid, Spain and disabled citizens. These extermination efforts were carried ABSTRACT: During the Nazi period numerous doctors and nurses played out with the active cooperation of physicians and nurses, many a nefarious role. In Germany they were responsible for the of whom had participated in the sterilization programs. The sterilization and killing of disabled persons. Furthermore, the fact that thousands of citizens were deprived of their rights Nazi doctors used concentration camp inmates as guinea allowed the Nazi regime to experiment on them with the pigs in medical experiments for military or racial purposes. A purpose of advancing their military capabilities, such as test- study of the collaboration of doctors with National Socialism ing chemical weapons, new drugs, and the limits of human exemplifies behavior that must be avoided. Combining endurance. Another objective of their experiments was to medical teaching with lessons from the Holocaust could justify their racial beliefs. be a way to transmit Medical Ethics to doctors, nurses and What we have learned about the behavior of doctors and students. The authors describe a study tour with medical students to Poland, to the largest Nazi extermination camp, nurses during the Nazi period spurs reflection on several Auschwitz, and to the city of Krakow. The tour is the final aspects of today’s medical care [1,2]. The latter include research component of a formal course entitled: “The Holocaust, a limits, decision making at the beginning and the end of a life, Reflection from Medicine” at the Autónoma University of and the relationship between the physician and the State. Some Madrid, Spain. Visiting sites related to the Holocaust, the authors contend that teaching about the role played by Nazi killing centers and the sites where medical experiments were doctors during the Holocaust could serve as a new model in conducted has a singular meaning for medical students. physicians’ and nurses’ education regarding Bioethics [3]. Tolerance, non-discrimination, and the value of human life Educational programs for health care workers must include can be both learnt and taught at the very place where such cross-curricular subjects that encompass respect for diversity. values were utterly absent. Studying the Nazi period provides an example of behavior that IMAJ 2016; 18: 257–260 must never, ever, be permitted. KEY WORDS: Holocaust, medical ethics, study trips, medical experiments, National Socialism TEACHING MEDICINE AND THE HOLOCAUST In 2011 the Autonoma University of Madrid, Spain, announced a call to faculty members for the creation of elective formal courses related to human rights, combating hate and discrimi- he Holocaust was one of the foremost historical events of the nation. These elective courses are complementary curricula T 20th century. Between 1933 and 1945, millions of people – included in the European Higher Education Area (EHEA). Jews, Gypsies, homosexuals, and gravely ill and handicapped We responded and submitted our project, “The Holocaust: a individuals – were exterminated. The racial policies that were Reflection from Medicine.” Our application was approved, and instituted in 1933 during the Nazi period led to the margin- since 2012 we have been engaged in teaching ethical values to alization and exclusion of several social groups. It began with medical students using this weighty subject as the model [4]. the forced sterilization of people born with disabilities and Each year the class comprises 70 students, the maximum num- culminated in the killing of those whose lives were considered ber allowed per class. worthless. The outbreak of World War II in 1939 prompted the begin- THE COURSE ning of the planned and medically supervised murder of sick Objectives • To compare the characteristics of current professionalism The first author is the course director of “The Holocaust, a Reflection with actions carried out by doctors during the National from Medicine” at the School of Medicine, Autónoma University of Socialist period Madrid. The second author is a professor of history who teaches the subject and is responsible for the organization of study trips to • To develop respectful attitudes towards differences – whether Holocaust sites. gender, cultural, health or other. 257 FOCUS IMAJ • VOL 18 • may 2016 Figure 1. Reading the testimony of Mrs. Eva Mozes Figure 2. Paying tribute to the victims at the Figure 3. Visiting Oskar Schindler´s Factory Museum Kor, survivor of medical experiments conducted by International Monument (Auschwitz-Birkenau) (Krakow) Dr. Mengele on twins (Auschwitz-Birkenau) Content majority of students are interested only 15 students on average • Historical introduction participate, the reason being that the trip takes place during • Role of doctors and nurses in Eugenics and Euthanasia the summer vacation. • Jewish doctors in ghettos and camps Visiting authentic sites creates a unique learning environ- • Nazi doctors in concentration and extermination camps ment, far different from that in the classroom. Being present • Medical experiments in camps at the very sites that heinous medical experiments were con- • Traces of Nazi medicine today ducted has a particular meaning for medical students. It is a • Psychology of Nazi criminals place where the values we want to transmit in our classes – such • What can we learn from the Holocaust for medicine today? as tolerance, non-discrimination, and the sanctity of human life What should we teach? – can be both learnt and taught. Clearly, teaching and learning of Bioethics during a tour of a concentration camp is not only METHODOLOGY possible, its impact is enormous. Our methodology is active, encouraging participation and We provide the students with educational material about debate. Every week each student prepares an assignment on the camps and ghettos, as well as testimonies of the victims. one of the five case studies presented and uploads it to the However, apart from the information that we provide it is online learning platform, Moodle . The case studies include essential that the students be prepared emotionally and psy- testimonies of victims, statements ®by Nazi doctors, and ethical chologically for the trip. The first day includes a seven-hour dilemmas. In the last module, under the title “What can we learn tour of Auschwitz. Stopping at several sites, the students read from the Holocaust for Medicine today?” students are tasked testimonies of victims, complementary information about the with finding news in the media on the degradation of profes- site, or poems [Figures 1-3]. We are fully aware that students are sionalism, misuse of the physician’s power, research limits, or deeply affected by what they see, especially at the gas chamber physician-government collaboration. Our aim with this activity and the barracks. Their reactions vary – some cry, some become is that the students comprehend that some of the events dis- physically ill, and some are unable to speak for a while. Clearly, cussed in class could in fact happen again. the teachers should be trained to cope with such situations. The students are asked to personalize the victims in order EVALUATION to see them as living beings and not merely a name or number. There is no exam. The final grade is an average of all the assign- That is why, when viewing some of the exhibits at Auschwitz, ments. Every year the university conducts a satisfaction survey we encourage the students to focus on a shoe, a suitcase or a for all students, where the highest score is 5; the average of our photo, and try to envisage the owner and the kind of life she last three courses was 4.81. In the comments section the students or he lived. stated that the class gave them a more humane perspective of On the second day, we walk through what used to be the medicine, they realized the importance of learning from history, Jewish Ghetto in Krakow. We also visit the Schindler Factory and that the subject is related to current events (unpublished data). Museum. These places provide the students with an idea of what life was like in Krakow before and during the war. We talk STUdy TOUR TO HOLOCAUST-RELATED SITES: about how Jewish doctors in the ghetto hospitals had to deal AUSCHWITZ AND KRAKOW (POLAND) with the shortage of medical supplies and the associated ethical At the end of each course, we offer a study trip to Auschwitz dilemmas, i.e., decision making and priorities. We also remind and Krakow (Poland) [Appendix 1] [5-20]. Although the our students how, despite the horrendous circumstances, they 258 IMAJ • VOL 18 • may 2016 FOCUS managed to conduct seminal research (for example on Hunger Correspondence disease) and succeeded in creating an underground medical Dr. E. González-López Dept. of Medicine, School of Medicine, Autónoma University of Madrid, school in the Warsaw Ghetto. Arzobispo Morcillo 4, 28029 Madrid, Spain Although it would be more logical to start our trip in Phone: (34-914) 975-377 Krakow and finish at Auschwitz, we decided on the reverse Fax: (34-914) 972-739 so as not to end with the memory of Jews as victims but to email: [email protected] acknowledge their lives before the Holocaust. We would like to make a suggestion to teachers who decide References 1. Rubenfeld S, ed. Medicine after the Holocaust. From the Master Race to the to visit Holocaust-related sites. It is vital to meet every day Human Genome and Beyond. New York: Palgrave MacMillan, 2010. before and after visiting each site. This allows the students to 2. Reis S, Wald HS. Medicine in the Third Reich: The new medical education talk about their impressions and emotions, and thus exteriorize agenda.
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