On Wednesday, according to Jezebel, several major news outlets like The Washington Post, Newsweek and The Daily Beast initially reported 17-year-old Noa Pothoven had died by assisted suicide in the Netherlands as a result of her mental health struggles. This version of the story is false.
Regardless, the coverage of Pothoven’s story has unearthed a lot of discussion about assisted suicide, the right to die and the availability of mental health treatments, especially for minors. To set the story straight and to provide more context about the complex issues Pothoven’s death brings up, here are three things you need to know if you see this story online.
Before we start, it’s important to know if you’re struggling with your mental health right now or thinking about suicide, the following might be difficult to read, so proceed with caution. You’re not alone, and help is available if you need it. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.
1. Many media outlets got the story wrong.
English media mistranslated the original Dutch news article about Pothoven’s story, and other journalists have since reached out to Dutch reporters to set the record straight. Pothoven did not die by assisted suicide or euthanasia. She died from refusing treatment, after exhausting or being refused many options, for her mental health issues.
According to journalist Naomi O’Leary, Pothoven lived with anorexia, post-traumatic stress disorder (PTSD) and depression after surviving several sexual assaults as a child. Pothoven and her parents fought to get her the mental health treatment she needed. In a 2018 article covering Pothoven’s story, Dutch journalist Paul Bolwerk reported Pothoven had received a variety of treatments. This included being placed in a medically-induced coma to force feed her because she was in critical condition as a result of her eating disorder.
Bolwerk said Pothoven’s parents tried to get treatment for their daughter repeatedly but were unable to find in-patient clinics or facilities to treat Pothoven’s anorexia or depression. The services were either inappropriate for minors or the waiting list to get treatment was too long. Pothoven’s mental health continued to worsen, and she made several suicide attempts. Her parents tried to get her in for electroconvulsive therapy (ECT), which has been shown to be effective for people with severe depression. Pothoven was refused this treatment because she was a minor.
Without her parents’ knowledge, Pothoven had approached a clinic in the Netherlands to ask if she qualified for legal euthanasia when she was 16. Assisted suicide is legal in the Netherlands under certain conditions, including terminal illness. Minors 12 and older can request assisted suicide, but their parents must be involved in the decision until they turn 16. Bolwerk reported Pothoven’s request was denied.
I spoke to Paul Bolwerk, a reporter who has been covering the story for @DeGelderlander since 2018. Noa Pothoven had been severely ill with anorexia and other conditions for some time. Without telling her parents, she sought and was refused euthanasia https://t.co/qpMdzPHEJZ
— Naomi O'Leary (@NaomiOhReally) June 5, 2019
With few other resources available, Pothoven said she wanted to refuse all further treatment. She entered palliative care at home under the supervision of her parents and doctors where she died on Sunday.
“She got depressed more and more, and … now I say I will stop with all treatments. And that was very stressful for everyone, including the parents, the doctors, the psychiatrists,” Bolwerk told Politico. “It was very hard to accept that for everyone.”
A decision to move to palliative care and not to force feed at the request of the patient is not euthanasia.
Dutch media did not report Noa Pothoven's death as a case of euthanasia. This idea only appeared in English language pickups of Dutch reporting.
— Naomi O'Leary (@NaomiOhReally) June 5, 2019
How Pothoven died is not considered euthanasia or assisted suicide, as journalist O’Leary pointed out on Twitter. “A decision to move to palliative care and not to force feed at the request of the patient is not euthanasia,” O’Leary said.
2. What you should know about assisted suicide in the United States.
Part of the reason the original — and inaccurate — story about Pothoven’s death gained viral attention is because assisted suicide and euthanasia are complex and controversial. It’s a grey area ethically and legally. In the United States, right-to-die laws are determined by individual states.
Assisted suicide, or assisted dying, is legal in a few states, including California, Colorado, Oregon, Vermont, Hawaii and Washington and Washington, D.C. Montana has a provision that allows court-mandated assisted suicide, but it’s highly debated. New Jersey’s law legalizing assisted suicide will go into effect on Aug. 1. On Tuesday, Maine lawmakers voted to legalize assisted suicide in the state, but the law is still pending the governor’s signature.
Most state laws have requirements for patients who want to die by assisted suicide. It’s often legally reserved only for people with a terminal illness who may have fewer than six months to live. Patients may need to make the request at least two different times for verification. Only doctors with M.D. or D.O. credentials are allowed to provide the treatment, and doctor participation is voluntary. Specific laws and regulations vary by state.
Physician-assisted dying is different than euthanasia. With assisted dying, a doctor gives an individual the means to kill themselves. The doctor does not administer the treatment. Euthanasia refers to a doctor administering lethal treatment directly. Currently, in the U.S., euthanasia is illegal in all states because it falls under many homicide laws.
Proponents of assisted suicide believe people have a right to die, just as they have the right to live with an illness and not seek treatment. How this may apply to mental illness hasn’t been given much consideration in the laws around assisted suicide. The Netherlands allows assisted suicide for physical or mental health conditions, but this is more unclear in the United States.
Officially, the American Psychological Association (APA) doesn’t take a stance on assisted dying one way or the other. However, many have pointed out when you live with a mental health condition, it can warp your world view. With depression or other mental illnesses, things may look so hopeless so it feels like your only answer is to die. At this point, advocates ask, can someone make a rational decision about assisted suicide, especially when we know mental health treatments are available?
Many also object to the right of assisted suicide for religious beliefs, while others are concerned it may give too much power to doctors to determine what a “life worth living” looks like. This is especially relevant to those with disabilities because oftentimes the medical community has a narrow view of what quality of life looks like. Some advocates argue assisted suicide laws can be used to coerce people into dying (or withholding treatment options) based on discrimination.
“There are a number of marginalized populations that are legitimately concerned about whether they are getting all of the best options in care at the end of life,” Carol Gill, Ph.D., professor of disability and human development at the University of Illinois at Chicago, said in an APA article. She added:
Having a meaningful life doesn’t necessarily mean that life needs to be pain-free or without physical impairment or functional limitations. What it means is to remain engaged humanly, and get enough support from others or technology to engage in the activities that matter, that make life meaningful.
The debate around assisted suicide and euthanasia hinges on how we define and limit personal freedoms versus the idea that life is sacred and should always be protected. Questions such as, “Can we force people to seek treatment?” or “Have we provided enough treatment options?” or “What does ‘terminal illness’ mean in the context of mental health?” leave more questions than answers.
3. There is help available if you’re having suicidal thoughts.
One of the most heartbreaking aspects of Pothoven’s story is how hard she fought and how hard her parents tried to get her additional treatment. Good in-patient treatment and alternatives like ECT weren’t available to her, and Pothoven made a choice based on her options. Mental health services in the Netherlands are of course different than in the United States.
There is help available if you’re struggling with your mental health or thoughts of suicide. One study found that of those included in the large sample, nearly 33 percent who reported a long-term mental illness that seriously impacted their lives had not experienced symptoms in the last 12 months. The researchers also found that recovery increased after age 32, increasing to 58 percent by age 65. According to Mental Health America (MHA), nine out of 10 suicide attempt survivors do not go on to complete suicide in their lifetime.
Mental health treatments, including psychotherapy, medication and others, are effective. That doesn’t mean there aren’t challenges to accessing services here in the U.S., however. Per National Alliance on Mental Illness (NAMI), nearly 63 percent of those with serious mental illness received treatment in the last year, but there are often long waiting lines to access services. MHA did report that mental health advocacy is helping to expand treatment resources.
If you’re struggling, know you are not alone and help is available. For local treatment resources and options in your area, call NAMI’s helpline for free support and information. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or reach the Crisis Text Line by texting “START” to 741741.
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For other stories that have helped The Mighty community, check out the following articles:
- What People Who’ve Been Suicidal Want to Tell Someone Who’s Suicidal Today
- What I Want You to Know as a Crisis Counselor for the National Suicide Prevention Lifeline
- For Anyone Who Doesn’t Like Reaching Out for Mental Health Help
- 4 Tips for Getting Mental Health Care If You Don’t Have Insurance