On June 3, at 2:40 a.m., Dutch teenager Noa Pothoven died in her home, surrounded by family. Her sister posted the news on Instagram.
Within hours, her death made headlines around the world because some media, led by the British tabloids, reported that the 17-year-old had died by “euthanasia.”
That wasn’t true, but nonetheless triggered a polemic about the horrors of allowing teenagers, people with mental illness, or anyone for that matter, to choose an assisted death.
The media took a beating too, and deservedly so. In the rush to get a juicy story out quickly, they made some grossly wrong assumptions, neglected basic fact-checking, and engaged in some shameful click-baiting.
Still, Ms. Pothoven’s story offers up some important lessons, especially for Canada, where laws on medically assisted death are still being shaped.
In her book Winning or Learning, Ms. Pothoven told a horrific tale of being sexually assaulted at the age of 11; a year later, assaulted again at a classmate’s party; and then raped by two men at the age of 14. The assaults led to years of increasingly debilitating post-traumatic stress disorder, depression, anorexia and mental health problems.
“To this day, my body still feels dirty,” she wrote. “My house has been broken into, my body, that can never be undone.”
The teenager made several suicide attempts, both before and after she decided to go public with her story. At 16, Ms. Pothoven approached an End of Life Clinic and asked for an assisted death.
The request was refused.
So, last month, the 17-year-old decided to take matters into her own hands. On Instagram, she wrote, “I breathe but I no longer live,” and said she would be dead within 10 days.
Ms. Pothoven decided to end all medical treatment and to stop eating and drinking.
While her parents did not fully endorse the decision, they agreed to not intervene (earlier treatment for anorexia included involuntary feeding) and physicians provided sedation to minimize her suffering.
A case such as this one elicits many emotions, even for the staunchest supporters of choice at end-of-life.
It also underscores how little we know about, or discuss, how we die.
In Canada, the large majority of deaths occur in hospital, in a fairly predictable manner – with cancer, cardiovascular disease and chronic obstructive pulmonary disorder making up most cases.
Many people opt for VSED – voluntary stopping of eating and drinking. Most patients, at some point, refuse further treatment, other than pain relief.
These routine end-of-life choices are sometimes referred to as “passive euthanasia.”
What Ms. Pothoven did is the norm – except she was a teenager, and her suffering was mental, not obviously physical.
Where it is legal – such as The Netherlands and Canada – patients can opt for assisted death – where drugs are used to hasten death. The term “active euthanasia” is sometimes used.
And more people die by suicide than by assisted death.
There are some subtle differences between these manners of dying, and the lines can sometimes be murky.
The rules around assisted death, however, tend to be strict.
Under Dutch law, which took effect in 2002, patients requesting assisted death must have “unbearable suffering without prospect of improvement.” They can make the request as young as 12, and after 16, do not require parental approval.
Ms. Pothoven said the physicians who reviewed her request for euthanasia felt her recovery could not be deemed hopeless until her brain was fully developed at 21. “They think I’m too young to die,” she told the Dutch newspaper de Gelderlander.
In Canada, a request for medical assistance in dying (MAiD for short) like hers would have been refused outright. Under Canadian law, only patients older than 18 can request MAiD and their death must be “reasonably foreseeable.”
That controversial clause, practically speaking, rules out MAiD for people with mental illness as their principal diagnosis.
In fact, the Dutch case is quite similar to that of Canadian Adam Maier-Clayton, who took his own life at 27 after being refused assisted death. He also announced his intentions on social media in the hope it would force legal changes.
As we flirt around the edges of MAiD legislation, the lines between legal and illegal, ethical and unethical, become more blurry, and the reporting more messy.
But we must never lose sight of the ultimate purpose of assisted death – to reduce the suffering of those whose pain, physical or mental, is unbearable. That choice, that relief, must be open to all, no matter how uncomfortable it may make us.
André Picard