That debate is important but misplaced: Pothoven’s story is not about euthanasia. It is about a 17-year-old girl who never found the help she needed to survive the trauma of two separate sexual assaults, and about the mental-health system that fails many other people like her.
Though it took time for the record to be corrected, at this point, we know the end of Pothoven’s story well. In 2018, she approached the Levenseindekliniek, an end-of-life clinic in The Hague, requesting euthanasia. Her request was denied on the basis that she was too young. This June, she died in a hospital bed in her living room after she stopped eating and drinking.
But there has not been nearly enough discussion about the tumultuous years preceding her death. Pothoven said she was assaulted for the first time when she was 11, and then raped by two men three years later. (She did not feel psychologically able to make formal police reports, and her alleged assailants will not be prosecuted.) Though her caregivers did not learn about her trauma until years later, these events triggered severe symptoms of anorexia, post-traumatic stress disorder, depression and other psychiatric disorders.
“I have been in care for years,” she wrote in a blog post published in a university paper. “… I am getting worse and worse.” She was clear about the root of her problems being PTSD, but she only received treatment targeting her symptoms, which she found to be ineffective at best and damaging at worst.
“We actually want one place for her,” her mother told the Dutch newspaper Algemeen Dagblad, “where she can stay and where all her physical and mental problems are addressed.”
But those institutions had months-long waiting lists. Instead, Pothoven was treated as an inpatient between 20 and 33 times, sometimes involuntarily, in as many as 23 institutions. She was held in isolation for months against her will — an experience she repeatedly described as humiliating. She was also placed in an institution normally reserved for people with “serious behavioral issues,” often people who have been committed for being aggressive or violent, explained Dutch activist Pieke Roelofs, who also echoed the mistreatment of inpatients held in isolation. Pothoven, Roelofs and Peer Van der Helm, a lecturer and psychologist who worked with her over four months, noted that being housed with potentially violent boys risks retraumatizing people who have experienced sexual violence. “My eating disorder likes it here,” Pothoven wrote in her memoir.
Freedom wasn’t always a better alternative: Institutions that focused on one of her symptoms often ignored or exacerbated others. Pothoven mentioned that anorexia treatment was ended as soon as she hit a target weight, but she was given no additional resources to address the underlying problems that fueled her distorted relationship with food. Another facility where she was admitted after suicide attempts prevented Pothoven from harming herself but failed to treat her anorexia and PTSD.
Not only were the institutions themselves unhelpful: Many of the staff were as well. After asking for help over the intercom after having harmed herself, one caregiver told her they “don’t have time for [her] nonsense.” Before she went public about her experience with rape, another caregiver told her she had “no right” to be so troublesome — “you have not been raped or something.”
Although the details of Pothoven’s death are unusual, her story, unfortunately, is not. Roelofs, who has extensively navigated the Dutch mental-health system, highlighted how common it was for inpatients to be discharged too soon. Van der Helm estimated that the decentralized Dutch health-care system has overlooked “250 Noas.” And the issues Pothoven faced in institutions, including a lack of trauma-informed care and a consistent invalidation of the effects of sexual violence, are not particular to the Netherlands.
In the United States, the number of people suffering from serious mental-health issues has skyrocketed since 2009. The suicide rate for teens ages 14 to 17 shot up by more than 60 percent between 2009 and 2017, and there have been sharper increases among girls than boys.
Yet access to mental-health support remains expensive and inaccessible. Like the Netherlands, the United States lacks beds in psychiatric institutions that provide more comprehensive care, a change driven by the deinstitutionalization efforts that began in the 1950s and 1960s. The community health centers that were meant to be alternatives are dramatically underfunded.
Pothoven was a precocious and talented writer who tirelessly advocated for herself and others in similar positions. A report by an unreliable news source turned her life into a story about euthanasia. Instead, her legacy ought to be a robust conversation about the mental-health systems that fail young people, women and all those who have experienced sexual assault. Ending euthanasia couldn’t have saved Noa Pothoven. Improving mental-health care might prevent another tragedy.
Charles Lane: How many botched cases would it take to end euthanasia of the vulnerable?
Abigail Hauslohner: It should never be too late to tell your story of rape. 14 years later, this is mine.
Ryan T. Anderson: Maryland’s end-of-life bill is about one thing: Killing
Rosalynn Carter and Patrick J. Kennedy: We must treat mental and bodily health the same. It’s a matter of human rights.