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Jeanne Smits, Paris correspondent

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Dutch teenager tragically starves herself to death

Jeanne Smits, Paris correspondent

ANALYSIS

June 6, 2019 (LifeSiteNews) — The death of 17-year-old Noa Pothoven made world headlines earlier this week as the international press described the “euthanasia” of the young Dutch girl in Arnhem, Netherlands.

Shocked reactions abounded, especially since her death was associated with profound psychological suffering after experiencing sexual abuse at ages 11 and 12 and a double rape when she was 14. This was not a terminally ill cancer patient who could no longer bear physical pain but a vibrant teenager who had suffered “a fate worse than death” when she was little more than a child and whose depression finally led her to refuse life itself.

Those reactions were healthy ones. But there was a twist to this story: basic and even perfunctory fact checking had not taken place. Mainstream media that so eagerly condemn “fake news” passed on the information without verifying Dutch sources that were very clear about the cause of Noa’s death: She had voluntarily stopped eating and drinking in order to die. So? No euthanasia was involved …

The mainstream liberal media corrected their reports while fact-checking agencies spoke of “erroneous or exaggerated news stories” in tabloids as well as “ordinarily reliable national news media” debunking their “sensationalist” approach. Surely, Noa Pothoven is dead, but there was no question of euthanasia or even assisted suicide, so probably everything was OK.

Or was it?

Was her death truly, in some way at least, “normal,” and even “due to natural causes” as her death certificate states? Doesn't her tragically shortened life still raise the same questions as direct euthanasia on a minor would have done? Is starving yourself to death with the assistance of medical providers somehow “better” than getting a lethal injection?

Until she was 11, Noa Pothoven was a cheerful, intelligent, happy youngster. A bright pupil, she had effortlessly made the move to secondary school and had a knack for writing, which she loved.

Then she went to a school party, where she was inappropriately touched by a man. A year later, the same thing happened at another party for adolescents. Two years after that, the beautiful blonde girl was raped by two men somewhere in Arnhem. She never told her parents because of “fear and shame.”

“I relive that fear, that pain, each and every day,” she told a television interviewer last December at age 16. “I'm always afraid, always on my guard. And even today my body still feels dirty. My house, my body was broken into, and that can never be undone.”

Noa Pothoven had become depressed and anorexic after the assaults. She had behavioral disorder and started self-harming. Several suicide attempts would follow and at one point she was taken to a hospital where she received enteral feeding for many months and was even put in coma while waiting for a place in a specialized psychiatric institution for adolescents. She was moved from one clinic to another, never finding the treatment that she hoped would save her from her despair.

Lisette and Frans Pothoven only found out about their daughter’s death wish when they stumbled upon an envelope in her room full of “goodbye” letters to her parents, family and friends. They could not understand. “Noa is sweet, beautiful, intelligent, sociable and always cheerful. How can she want to die?” her mother told a reporter in the same television interview.

They would only learn about the sexual abuse and rapes their daughter had gone through when she was 15 and had already started starving herself.

In the meantime, therapists encouraged Noa to write about her thoughts and feelings. Her writings grew into a book that was published last December, Winning or learning. She explained that while writing she realized more and more that she did not want to go on living.

“Yes, that came slowly to the fore,” she told the reporter: “The feeling that it would perhaps be better if I wasn't there anymore, because then other people won’t be disturbed by me and I wouldn't be disturbed by myself.”

At the time of the interview last December, Pothoven explained that that had led to a “euthanasia trajectory.” She is known to have gone to the End-of-life Clinic that deals with euthanasia demands doctors do not want to meet,  but she was turned away because she did not fill the legal conditions.

She complained that euthanasia was being withheld because she was too young. Doctors explained to her that the human brain is still maturing during adolescence and that these requests on psychiatric grounds are only taken into account after a patient has turned 21.

“That really broke me: I can't wait that long,” she told the journalist.

Her story reads like the chronicle of a death foretold. Not only did she want to die, but the whole world knew it thanks to her book. What she had omitted or feared to tell her family, she finally laid bare for all to read. Journalists and readers discussed her will to die. She never got the help and healing she admitted she was looking for.

She complained that she had been forcibly committed to psychiatric institutions by “people in judge’s robes” who made her “feel almost like a criminal.”

Was there ever any spiritual help for Noa? Did she or her parents believe in an afterlife, or ultimate justice for those who soil the young? And shouldn't we be talking about a form of complacency on the part of the media toward her tragic suffering, looking on until she finally died?

Her mother, Lisette, said she hoped that going public with the story would help find a solution, complaining that there is not a single closed institution in the Netherlands where Noa’s needs, both psychological and physical, would really be cared for. The young girl was repeatedly put on waiting lists. She was prepared to try anything, including electroshock treatment, which was ultimately refused according to one source.

Her parents kept hoping something would change. In the December 2018 interview, Lisette  sorrowfully acknowledged that her daughter was on the road to choosing death: “We are at right angles to her about that. We, her parents, want her to choose the road of life. In reality, Noa does not want to die at all. She is only longing for rest.”

Noa agreed. “Yes, I want rest. I no longer want to feel pain.”

How, when and why her medical caretakers and family accepted a few months later that the girl should “refrain from eating and drinking to hasten death,” as the procedure is known in the Netherlands, can only be imagined. The Pothovens, who have been submerged with requests for interviews and information by the foreign media since their daughter died last Sunday, have pleaded to be left alone and mourn in peace.

What is certain is that she died in a hospital bed set up in her parents’ living room, receiving specific care for those who choose to stop living by refraining from nourishment in order to die of thirst and denutrition. A particularly horrible death, but it is open to anyone who wants it in the Netherlands, and caretakers are required to assist during the procedure.

Notably, however, those caretakers who have conscientious objections – emotional, moral or religious – are allowed to step back to let others who are prepared to “accompany” such a “chosen death” provided they do give care in emergencies and no one else is available.

The very fact that conscientious objection is possible in this situation shows that it is no ordinary thing and raises serious moral issues.

In fact, according to the official guidelines of the KNMG (the Royal Physicians’ Association of the Netherlands), “conscious refraining from food and drink” in order to hasten death (or in the case of Noa, to cause it speedily and outright) is “explicitly discouraged” under 60 years of age when the patient is not suffering from a “terminal illness.”

For people over 60, on the other hand, there is no such requirement and any person can ask for help with this end-of-life choice on the basis of “patient autonomy.” the idea is that all patients are allowed to refuse treatment, nursing and ordinary care if they so wish. “It's a choice that everyone can and may make,” say the KNMG guidelines.

That 64-page document makes an interesting and even terrifying read. While doctors and other caretakers are encouraged to dissuade patients from choosing to stop receiving food and liquids and to search for solutions that will help them go on living, the guidelines do suggest that the procedure can be an alternative when euthanasia is refused.

They add that patients suffering from depression should not be prevented on that count from choosing such a death because they are still capable of making their own informed decisions.

No mention is made, however, of underage patients. In the case of Noa Pothoven, it is not clear whether her parents were required to sign the documents requesting for the procedure for their minor daughter, but they certainly agreed to it. Under what pressure? And what was the part played by the euthanasia mentality that has crept so deeply into Dutch society?

The official guidelines are careful to explain that “consciously refraining” from food and fluids cannot be considered to be euthanasia or assisted suicide, because the process is slow and can be stopped if the patient decides it is too hard or because he or she decides to go on living after all.

But this sophistry is difficult to accept. There is certainly a decision to end one's life prematurely. In the case of an anorexic and depressed girl, refusing food is at the heart of her mental illness and moral responsibility, if any, would be hard to assess. Near and dear ones may be led to accepting it when they are at wit’s end, looking for help that doesn't come. But that doesn't make their decision objectively correct.

On the other hand, doctors, nurses and caregivers actively cooperating is much more questionable. The KNMG guidelines clear them of all responsibility by assimilating the procedure to the refusal of artificial ventilation, chemotherapy, antibiotics and other types of treatment whose withdrawal would ultimately cause death. This argument relies on the confusion between medical treatment and ordinary care that is always due the patient.

A second argument makes clear that the procedure requires acts, on the part of the caregivers, that are not in direct relation with the patient’s “hastened death.” This is of course true. Giving pain relief, taking care of the ugly symptoms of death by dehydration and starvation, making sure the patient is not uncomfortable and even sedating him or her (as lightly as possible when it becomes necessary to alleviate the suffering, the guidelines say) are not acts that provoke the decease.

But it is difficult not to see them as part of the suicide, slow though it may be. They surely amount to not helping a person who is in peril of death. But the idea is to condone an alternative to euthanasia and assisted suicide that doesn't quite have the feel of those two objective crimes.

The KNMG guidelines give many technical details about the problems and specific pain and suffering the kind of death Noa chose bring about. Terrible thirst is one of the symptoms, and the younger the patient the worse it is. Organ failure, constipation, impossibility to urinate, wasting of the muscles are just some of the effects of ceasing to drink and to eat.

Often, delirium sets in. The guidelines note that in their confusion, dying patients sometimes start begging for water. They make clear that it is very important that family members and caregivers do not give in to the patient's supplication, because he or she can at that point no longer be validly expressing a conscious will to drink and because giving fluids would prevent the death the patient was hoping for.

Doctors are encouraged to explain this to their patients and to have them sign forms making clear that at no point they should be given fluids, even if they ask for them, once they are judged unable validly to express their will.

According to the same logic, palliative sedation can be applied without the patient's consent, although their families can be consulted about the matter.

How is this all supposed to be humane and “dignified?” In what way is such a procedure not the deliberate helping of a vulnerable person to die? And is anyone thinking about Noa Pothoven’s immortal soul?

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