UPDATE: I now have a copy of the Washington Post article, which says that Noa was turned away from euthanasia consultation because she was too young. Further, we learn again, as I mentioned in Faith Versus Fact, that the most vocal opponents of euthanasia are religionists. Here, for example, is what Pope Francis said, the cluless git:
The Vatican mourned her passing Wednesday morning on Twitter. “Noa’s death is a great loss for any civil society and for humanity,” Pontifical Academy for Life wrote. “We must always assert the positive reasons for life.” Pope Francis, in a separate message, stated, “Euthanasia and assisted suicide are a defeat for all. We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope.”
What were the positive reasons for Noa’s life? Does the Church’s judgments outweigh hers in that matter?
It’s almost like the church wants her to suffer. In fact, the Church often likes that: Mother Teresa thought the suffering of her “dying destitutes” was good because it enabled them to experience the suffering of Jesus.
_____________________
The idea of “euthanasia” is repugnant to many people because it conjures up images of the Nazi treatment of children and the genetically “unfit”, or of your grandmother being forcibly killed against her will. In fact, “assisted suicide,” as it’s also known, is legal in seven U.S. states and in eight countries or parts of them. I consider the responsible and legal implementation of assisted suicide as a sign of an enlightened society, to be used only when there are strict guidelines and the patient is suffering unbearably with a terminal condition (that condition includes depression and mental illnesses when they cannot be cured despite extensive efforts).
Assisted suicide for the incurably depressed is in fact legal in the Netherlands, but is not often used, and operates under strict rules. While it has been used (see here, for instance), it is quite rare, and in some cases having that option has made people who initially wanted to die decide to live.
Here is a summary the Dutch law from Wikipedia:
Netherlands is the first country in the world formally to legalise euthanasia. Physician-assisted suicide is legal under the same conditions as euthanasia. Physician-assisted suicide became allowed under the Act of 2001 which states the specific procedures and requirements needed in order to provide such assistance. Assisted suicide in the Netherlands follows a medical model which means that only doctors of patients who are suffering “unbearably without hope” are allowed to grant a request for an assisted suicide. The Netherlands allows people over the age of 12 to pursue an assisted suicide when deemed necessary.
The mental illness issue is controversial, as many people think that the severely depressed and suicidal should be forced to live unless they decide to kill themselves on their own. I disagree, as in some cases depression does cause unbearable misery and is incurable. In those circumstances, and with proper legal and medical restrictions, I feel that such people should be allowed medical intervention to die. I know others won’t agree with me, but I see no use in prolonging unbearable suffering. (You can say that the depressed person might get undepressed, but terminally ill patients have also been known to recover, and those with treated but chronic suicidal depression for years are unlikely to revert.)
At any rate, yesterday there were many reports in both the popular and social media yesterday that a depressed 17-year-old Dutch victim of rape, Noa Pothoven, was euthanized by Dutch doctors. In fact, this was not the case: doctors refused to euthanize her (she was anorexic, severely depressed, had tried to kill herself several times, and had been institutionalized and given medication—all without improvement). As the Twitter feed below reports (and some checking indicates that it’s apparently true), Pothoven was refused legal euthanasia. She decided to die by refusing all food and water, in effect going on a hunger strike, knowing that this would kill her.
What the doctors did was palliative care that involved not force-feeding her. Can you object to that? What is indisputable is that this is not euthanasia, but suicide, with doctors not intervening in a way that would have doubled her suffering. Again, this is not euthanasia, which requires direct action by doctors to take someone’s life.
But such is the opprobrium of even the word “euthanasia” that the Western press (but not the Dutch press) almost uniformly reported this as euthanasia via medical intervention. Here, for example, is a result of a Google search this morning for “Rape victim euthanized”. Every article here says that she used “legal euthanasia”:
And some screenshots from Google:
If you read some sources closely, like The Daily Beast, you get a sense that “legal euthanasia” wasn’t really going on here (but who reads beyond the headlines these days?). Nevertheless, even that venue, and the Washington Post, report it as “legal euthanasia”. From the Beast:
A 17-year-old Dutch girl chose to be euthanized at her home last week after she said the pain of being raped and molested as a child had become “unbearable.”
Noa Pothoven, from Arnhem, Netherlands, wrote in an Instagram post a day before her death that she breaths [sic] “but no longer lives.” Her sister confirmed her death on Sunday. The Dutch first legalized euthanasia in 2001, the same year that Pothoven was born.
“It’s finished. I have not really been alive for so long, I survive, and not even that… I will get straight to the point: within a maximum of 10 days I will die,” Pothoven wrote in her native Dutch on Saturday. “After years of battling and fighting, I am drained. I have quit eating and drinking for a while now, and after many discussions and evaluations, it was decided to let me go because my suffering is unbearable.”
That “within a maximum of ten days” is a clue that she was not going to be euthanized with an injection or drinking barbiturates: this is a time-frame for dying by refusing liquids. But the Beast still characterizes implies that it was legal euthanasia:
In her book [Pothoven’s book Winning or Learning], she wrote that she was sexually assaulted at a school party when she was 11 years old, and was raped by two men just three years later when she was 14 years old.
Her mother, Lisette, said at the time that her daughter’s book should be mandatory reading for social workers and those responsible for adolescent psychological care. She also publicly criticized the fragmented mental-health system in the Netherlands, calling the bureaucracy “maddening.”
Pothoven had previously sought services at the End of Life Clinic in The Hague, but was reportedly turned away due to her age. Children as young as 12 can legally seek to be euthanized in the Netherlands, but a doctor must first determine that the patient’s pain is unbearable before they can be accepted. Seven such cases were accepted between 2002 and 2015, according to Alliance Vita, an international association that aids individuals and policy makers dealing with bioethical issues.
The practice was intended for those suffering from terminal cancer and similar excruciating physical conditions, but the law also allows people suffering from severe psychological pain to seek euthanasia. It is limited to those with intact mental faculties and “unbearable and hopeless suffering.”
Under Dutch law, the patient must repeatedly ask to die, a second doctor must agree in writing that the death is justified, and a post-mortem panel, made up of a doctor, a jurist, and an ethics expert, have to confirm that those requirements have been met.
Even the Washington Post reported in its headline that there was euthanasia involved:
I can’t read the entire article (it’s behind a paywall at the screenshot link), but I notice that at the top of the report there is now a “clarification”: “An earlier version of this story reported that Pothoven’s death came via euthanasia. It is unclear whether doctors assisted in her death, though she earlier requested their help.”
Nevertheless, the worldwide media reported this as legal euthanasia. Besides The Daily Beast and the Washington Post, misreporting occurred by the Independent and a gazillion other sources (just do a Google search). In fact, it’s hard to find an accurate account of what happened. Even if they say she died after “requesting euthanasia,” which is formally correct, you’ll almost never see reports today that she died after refusing food and water. The corrections will start trickling in later—if ever.
A few places that got it right are here, here, and the Twitter feed below from Naomi O’Leary, a correspondent for POLITICO Europe.
Infuriatingly, it's too late: this misinformation has already spread all over the world from Australia to the United States to India. Her name, #noapothoven is even trending in Italy. pic.twitter.com/CN22J7xdkK
— Naomi O'Leary (@NaomiOhReally) June 5, 2019
The family had tried many kinds of psychiatric treatment and Noa Pothoven was repeatedly hospitalised; she made a series of attempts to kill herself in recent months. In desperation the family sought electro shocktherapy, which was refused due to her young age.
— Naomi O'Leary (@NaomiOhReally) June 5, 2019
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
I had immediate questions reading the Dutch articles about whether this was a case of euthanasia or not. It would have been an enormous deal in the Netherlands if a 17-year-old really had euthanasia. It's really easy to check. Like I say, took me about 10 minutes. Infuriating.
— Naomi O'Leary (@NaomiOhReally) June 5, 2019
If you ever worry about whether you can trust a story or not, a good way to check is to look up whether @Reuters is reporting it or not. I trained to be a journalist with @Reuters, this is what they do.
— Naomi O'Leary (@NaomiOhReally) June 5, 2019
Here is Pothoven with her book. She’s gone now, and it’s very sad, but I can’t say that she made the wrong decision.
The lesson is that even the mainstream press will hop on a story without proper vetting. And, of course, this was all over social media, reported as legal euthanasia with Pothoven being killed via medical intervention. That doesn’t seem to be the case, and though there’s a chance that I’m wrong and that she was euthanized, I would bet lots of money that the report of refusal to eat or drink is correct.
Reporters are simply not doing their job these days, and it’s even worse because, when I checked some of the sources above, none had retracted their claims of euthanasia or even cast then in doubt like the Post did. Such is the sensationalism of the word “euthanasia”, and the hunger for clicks by even reputable journalistic sites, that proper vetting wasn’t done. This misreporting is itself a story, but will you see that anywhere?
But there’s room for debate in the comments: do you think euthanasia should ever be allowed for those suffering from mental illness? And feel free to give your own take on when (if ever) euthanasia should be legal.
“The lesson is that even the mainstream press will hop on a story without proper vetting.”
A friend from the UK just reported a story that someone (no one actually knows who) had several pro-Brexit letters published in various UK newspapers. The only difference in the letters where the date the person supposedly arrived in the UK and the address. In none of the cases was the address given a valid residential address. In at least one case, the address doesn’t even exist.
The name on the letters was Russian (are the even bothering to conceal it anymore)? And the letters mention a post-apocalyptic (if Brexit doesn’t happen) book supposedly authored by the same person who wrote the letters.
Only one newspaper in the 8 or so that got letters investigated. The rest published the letter without qualifications.
“The name on the letters was Russian (are the even bothering to conceal it anymore)?”
Are who even bothering to conceal it any more? If you were writing to the papers with a pro-Brexit message you certainly wouldn’t give a fake Russian name. This sounds more like a ‘false flag’ operation.
(Though I think Brexit is monumentally stupid and I hope they have the common sense to drop it).
cr
John Oliver presented a story on the death penalty. Part of that story was there is no painless or euphoric way to execute prisoners due to multiple factors such as types of drugs available.
It made me wonder what the difference between execution by lethal injection and euthanasia is. I surmised the difference for euthanasia is there are specific pharmaceuticals that are possibly expensive but ensure a pain-free experience, but for the prison system they don’t do that.
All you have to do is arrange for the air that the person breathes to have no oxygen in it and no carbon dioxide. It’s the carbon dioxide concentration the alerts your brain to the possibility of suffocation. So you can kill people painlessly simply by putting them in an atmosphere of pure nitrogen.
Michael Portillo tried it (only up to a point) in his documentary about finding a humane method of execution.
Similarly, people have mentioned that dealing with argon, krypton and xenon is occasionally hazardous because they will sink and crowd out oxygen (sort of).
Nitrogen can do that too – if you’re handling bulk nitrogen as the liquid, the possibility of forming pools of cold oxygen-deficient air at some distance from the LN2 tankers is always present.
So when preparing for a nitrogen gas-lift well test, all personnel in the area, or whose job is likely to take them through the area, get issued with a 4-gas meter (CO, CO2, H2S, lo-O2) and warned to wear it at all times outside the office/ lab spaces.
Well, they do in European rigs at least – I don’t know about American sites.
Oh come on. People kill themselves cheaply, painlessly, and even euphorically all the time — it’s called the “opioid epidemic”.
I’d trust John Oliver as far as I can throw him.
I’ve euthanized a lot of animals, all relatively painlessly.
Oliver’s point was not that it can’t be done (as you note it happens all the time), but that it can’t be done legally because the companies that manufacture the drugs have purpose exclusions and won’t sell them to states for executions. So they have taken to making their own, which doesn’t work out well. Also trained medical staff are prohibited from taking part, which is also “problematic”. It was a pretty grim piece but worth a look.
I will check it out, thanks.
A lot of (all?) pharmaceutical companies won’t supply drugs that are to be used for execution to prison.
Euthanasia is when they come for you.
Suicide is when you go to them.
It seems it is difficult to even find articles in the Dutch news. The big news papers do not seem to be reporting it (a quick search only gave me two articles; one at a newspaper, AD, and another at a magazine, Linda).
There is an interview with her from December in “De Gelderlander” which is very gripping, in a sense. It really sounds like for a long, long time she was not able to get the help she might have needed, and it makes me wonder to what extent that made things worse.
For a long time, her parents also did not know what had happened to her, why she suddenly became anorexic. It’s a really sad tale.
Going on a hunger strike must be a terrible way to go, also for those around you.
Is that interview online? I’d be interested in reading even a machine translation.
Here is the link to the interview:
https://www.gelderlander.nl/home/noa-16-uit-arnhem-is-nu-al-klaar-met-haar-verwoeste-leven~a01a7bd1/
Thanks.
From that article, on the delay in receiving treatment:
(Between Plattdeutsch and German, I was able to get a bit of the video, enough to recognize her determination and the despondency & frustration of her psychiatrist and parents.)
As it goes – The lie gets around the world in 5 minutes but the truth is still in bed.
This is the new Donald Trump form of journalism and also part of our instant on line get the story out regardless. No one pays for getting it wrong. For democracy to go down the tubes, the same must take place with journalism.
Why is Euthanasia so much different for other animals than for people. Oh, don’t tell me, I’ll guess religion.
You make a very good point. We all recognize that there are situations in which it’s simply cruel for a life to continue, and we apply that recognition in euthanizing animals, including our beloved pets. But because our culture is so anti-suicide, we force people to suffer even after having lost all those things in our lives that give them meaning, and because of mental health exclusions even in states where physician assisted suicide is legal, many people actually wish for a terminal illness to develop so they can avail themselves of the systems in place. The alternatives are generally violent, socially disreputable, and/or very unreliable and with terrible potential physical consequences for trying and failing in private. And very few people have the appropriate neurology to be able to starve themselves to death (I know for certain that I don’t have it), even if they strongly desire to die, and have come to the reasoned conclusion that it’s the best thing for them. Those stupid, animal drives with which evolution has saddled us are – for good, sound, biological reasons – very difficult to overcome.
“Why is Euthanasia so much different for other animals than for people. Oh, don’t tell me, I’ll guess religion.”
As you said. If you let a dog die with e.g. untreatable cancer without euthanising it, you’d be liable to prosecution for cruelty and the Twitterati would be condemning you as a monster. Yet if it’s your wife or child that’s what you’re supposed to do and helping them to end their misery is murder? Give me a break.
cr
I agree, and I’m glad we’re finally addressing the issue in NZ. I hope the Bill makes it through parliament and becomes law. I think people should have the choice to die in certain circumstances, including unrelenting depression.
I most fervently agree. I tend to get hot under the collar at the mendacious and deceptive alarmism of the opposition. (‘Old folks and the disabled will end up being euthanised’ – that sort of nonsense, along with the crop of ‘I wanted to kill myself but I was talked out of it and now my life is great’ useful idiots.)
cr
The correct usage of terminology is extremely important regarding end of life issues. Colorado passed Proposition 106 in 2016, namely, ‘Access to Medical Aid in Dying.”
https://www.colorado.gov/pacific/cdphe/medical-aid-dying
Yes, there are strict guidelines for someone to utilize ‘Medical Aid in Dying.’ One such guideline is ‘Medically able to Make One’s Own Decisions.’
Having served for many years on a hospital ethics committee, it is necessary to move away from such terms as ‘assisted suicide,’ ‘euthanasia’ and the like.
‘Futile Care’ is a common and challenging issue faced by doctors and medical staff.
Hah, but futile care is what you do before you give up and euthanize them. So what’s the new euphemism for the actual act of killing?
By the doctrine of double intent, doctors and patients (or families in pediatrics or with incapacitated patients) agree that the main goal of treatment should be alleviation of suffering and if death is hastened as a result, then that is acceptable and expected secondary outcome. This occurs in hospitals regularly and typically the discussion stays between the doctors and patients/families. This is in fact a well established practice in medicine.
Usually this is applied to physical suffering, but if a psychiatrist I trusted agreed with the patient that life long mental suffering and anguish was essentially a certainty, then I see no reason the doctrine should not apply to mental illness as well.
The term ‘futile care’ refers to the utilization of aggressive treatment modalities without benefit to the patient, that is, the patient is not improving and will never improve. Withdrawing such care allows nature to take its course, that is, allowing the patient to die. A patient at that point can enter into hospice care and receive appropriate ‘comfort care.’
The term ‘futile care’ refers to the utilization of aggressive treatment modalities without benefit to the patient, that is, the patient is not improving and will never improve. Withdrawing such care allows nature to take its course, that is, allowing the patient to die. A patient at that point can enter into hospice care and receive appropriate ‘comfort care.’
Tangential to the story, but: I can’t say I like the term ‘mainstream media’ at all. In my opinion, this is a dirty word now, soiled through its derogatory use by the extreme right who use it to undermine trust in any facts, so they can tell people whatever is opportune for their dirty game.
As old Wittgenstein said, the meaning of a word is determined by its use. And the way this term is used now is predominantly in the context mentioned above.
Here’s a pdf of the full WaPo article. It starts with a clarification. https://www.dropbox.com/s/xfublt9ki2lq6sn/Pothoven_WaPo.pdf?dl=1
Here’s the clarification: “Clarification: An earlier version of this story reported that Noa Pothoven’s death came via euthanasia, which she had initially requested. The Dutch Health Ministry said Wednesday that Noa’s family was maintaining that euthanasia — the definition of which is contested — had not occurred while indicating that the circumstances of her death were still being investigated.”
I think the “Clarification” needs a clarification.
Oh, hell yes. The thing that makes a party worth going to is the knowledge you can walk away whenever you want. People should be deemed to have complete autonomy over their own bodies, including the right to snuff it when the time comes.
I’ve got no desire to walk away anytime soon, but I can imagine there might come a time and circumstances when I’d long for quiescence; if I ever thought the ability to do so was going to be denied me permanently, I’d be tempted to snuff it right now. I can think of few fates worse than to be trapped in a persistent vegetative state, like that poor woman Terri Schiavo, only to have your destiny fought over by others — or, even worse, to have a conscious mind trapped inside a non-functioning body whose life you’re powerless to extinguish, like the Johnny who got his gun during WW1.
Being trapped in a persistent state of mental illness would be nearly as bad.
I agree. Unfortunately, in the US we seem to be far from enlightened on this issue. Even where assisted suicide is legal, it’s (AFAIK) not available for those with locked-in syndrome and similar “non-terminal” illnesses, which I agree seem like the worst things imaginable.
It is the right of every patient (or a child’s parents) to decline/withdraw care if there is no reasonable expectation of recovery or that a reduced quality of life will significantly improve.
In the pediatric ICU I most often deal with this situation in severe brain injuries (trauma and hypoxia from near drowning most common) which do not result in brain death but leave the child neurologically devastated. However, there is the potential for many years of life with home mechanical ventilation and a gastrostomy tube for feeding.
It is not at all uncommon for parents to elect to withdraw support and allow the child to die (although most parents elect to do whatever it takes to bring their child home). My understanding is that things are similar on the adult side except for a greater tendency to withdraw support. These are personal decisions and any reasonable choice will be supported.
If you wish to avoid being kept alive with locked-in syndrome or severe neurologic injuries, the best way is to make your wishes known. Tell your primary care doctor, your designated surrogate decision maker, and make it clear in a living will.
The only times patient/family preferences are not honored are when the preferences are not known or if the decision is unreasonable (continuing to ventilate a brain dead patient for example).
“People should be deemed to have complete autonomy over their own bodies, including the right to snuff it when the time comes.”
I couldn’t agree with you more, Ken. My problem is that assisted suicide doesn’t amount to “complete autonomy over their own bodies,” which is precisely why it’s called “assisted.” Also, I don’t like the idea of the State being in the position of deciding who meets the eligibility requirement for taking their own lives and who doesn’t.
I’m probably in a minority here, but I’d much prefer having painless means of “snuffing it” made available over the counter. Potential for abuse, sure, but we sell guns, knives, ropes and other means of suicide OTC, why not lethal drugs as well?
And I just learned that today is National Donut Day, so there’s another example. 😊
Doughnuts will be my assisted suicide😀
‘over the counter’.
I tend to agree.
Well, a cylinder of nitrogen is available for anyone who has the means to buy it and transport it.
Problem is, many people in the situation of needing to ‘end it’ can’t get out of their beds, let alone get to the pharmacy. If anyone can justly demand ‘assistance’, it’s them.
cr
Hmmm, turning cylinder of nitrogen into a successful suicide without any other equipment … well, I’ve done a lot more gas-handling than most people and I’ve figured out a way. I’m not so sure for Joe Soap.
Oh, sources … again, I can come up with 3 probables in town (and I don’t know this town well), but again that’s because of interesting experiences in the past.
In the process of establishing a justification for euthanasia, it will benefit everyone involved. Euthanasia should be available to anyone who seeks it, like counseling. The process will help family member come to grips that their loved one can no longer manage, or, perhaps, in the case of psychological trauma the process will cause the victim to opt out of euthanasia.
I see no disadvantages to euthanasia when it becomes a procedural therapy that gathers information, allows time for comprehension, rather than inevitable termination.
Pothoven had a lot going on beyond chronic depression (Dysthymia), including PTSD, anorexia, and severe self-cutting — a photo showed horrific scars on her arm — confirmed by her memoir’s full title:
Anorexia is itself a form of protracted suicide. My friend worked as a therapist at a clinic for ‘late-stage’ anorexics. She said the long-term recovery rate was close to nil, with success being measured in keeping the patient alive another six months. The life expectancy of an anorexic is age 25.
Pothoven and her mother complained no effective treatment programs were available. I have no information to assess that complaint. Perhaps clinicians merely addressed the surface symptoms without searching for the underlying etiology. But it’s likely that no protocol would’ve made a difference for this individual. Also SSRIs, commonly prescribed for depression, can especially in teenagers, increase suicidal ideation.
As we learn more about brain science, *some* schools of mental health care have grown more effective, with therapies like CBT that manage, instead of futile attempts to cure. Often, though, the sufferer has built such an elaborate, harmful yet internally self-consistent world of ideation and behavior, that nothing nor no one can break through.
I’m concerned the narrative is being promoted with this story that severe traumatic experiences like Pothoven’s necessarily destroy one’s life. Obviously, many people with similar trauma go on to lead healthy, happy lives. Perhaps earlier, intensive intervention may have helped Pothoven. But she may also have been predisposed to respond this way, and any number of paths would’ve led her to self-harming, suicidal ideation, and unending misery.
Addendum: I see that Pothoven’s dysthymia was described as “medication resistant”, and she’d undergone Electro Convulsion Therapy which, despite it’s One Flew Over The Cuckoo’s Nest bad rep, has been rediscovered as effective in some cases.
Pothoven also alluded to struggling with ‘perfectionism’ before her assaults.
https://heavy.com/news/2019/06/noa-pothoven/
I gather she was refused electroshock therapy because of her age. If so, I find that unconscionable. It means that the full available range of therapies had not been exhausted.
Note, it is true that anorexia on top of other psychological ‘disorders’ appears to be one of the most resistant to therapy. I do not say it would have helped, but it might, We don’t know.
I agree with the OP that this is more a case of suicide than euthanasia. Whichever way we look at it, a tragic case.
From the Dec, 2018 article (h/t sgo):
Don’t know how it’s handled in the NL, but based on my therapist friend’s telling, the effects of anorexia needs to be fairly advanced & imminently life-threatening to merit aggressive treatment. Closing the barn door after the horse is gone, if you ask me.
I understand people’s extreme hesitance where euthanasia is concerned. When you consider how high the costs of end of life care are, not to mention that of nursing homes before that, it’s not hard to picture a world in which people were pressured into it, either explicitly or because they might feel like a burden on their families. It’s worth remembering, I think, that our healthcare system is extremely convoluted with many different players at each level, and any time you risk creating an unintentional incentive somewhere in that tangled mess, you’re playing with fire. There have been so many scandals already uncovered that went on for years unnoticed – incentives by HMOs to deny care and the opioid crisis come immediately to mind, but I’m sure there are others.
That said, I think in some cases forcing someone to live out a long degenerative disease really amounts to torture. If you simulated the conditions of many degenerative diseases in a prison, for example, you would most certainly be tried for just that – torture. That we demand people end their lives slowly, in gruesome circumstances, as they go through the pain of losing their dignity in front of their loved ones, strikes me as depraved.
In this particular case, I do think they should have insisted on a feeding tube for the teenager in question. Depression in one’s teenage years, when hormones are changing and the brain is still developing, is really not indicative of one’s adult life. Seventeen is not old enough to make a fully informed decision on such a matter. And I know this may sound hypocritical given what I said above, as I’m sure her depression was also a torturous situation – but there is a difference when recovery is very much possible. Little ones with childhood cancers, for example, have to go through so much for recovery – but it’s a very different picture when you know they can recover.
Pothoven had been on a feeding tube at times.
5150’ing, hospitalizing, and force-feeding and anorexic is but a desperate temporary measure to prevent imminent starvation. Once out of immediate danger, they are released and will begin again.
Maybe, maybe not – I think that is a decision for when they are an adult. I had two family members with significant anorexia requiring at least one hospitalization in each case for significant health issues. They both stabilized past their mid-twenties. They probably wouldn’t be counted in any studies of eating disorders as they never officially admitted to them, that I know of, but their weights were low enough to cause issues with major organ functioning.
An aside – I think treatment for anorexia has suffered due to the fact that people have hung on to a psychoanalytic model for so long. Something about young girls becoming increasingly frail and waif-like is romanticized and, in my opinion, even a bit fetishized in our culture, and I feel like people with eating disorders have every weird *ss story out there projected on to them. This has not been the case for issues such as OCD, panic attacks, bipolar disorder, autism, etc., etc. I know that personally, I have loved food all my life and never had an issue with eating until about three months ago, when I assume my bloodstream filled up with GDF15 from the little guy occupying real estate in my belly. Entirely biochemical, but my relationship with food changed so fast – just the idea of looking at it, being around it, and so on. Even colors or patterns that *remind me of certain foods are aversive. I feel like research into eating disorders spent too much time running down romanticized blind alleys and hasn’t done enough research into biochemical issues.
I’m still trying to understand Pothoven; I’m not endorsing assisted suicide in her case.
I’ve known recovered anorexics, too — the prognosis is dire but not certain. It does seem that too often, the focus is on treating the symptom, not the underlying cause. And therapy is a crap shoot, as many non-scientific, ineffective modalities are still common.
A significant heritability has been found for anorexia. It’s also commonly comorbid with perfectionism, which Pothoven exhibited in childhood.
The emotional reason(s) given by an suicidal person must be taken with a grain of salt. They are most likely predisposed to suicidal ideation — it pretty much comes with dysthymia — and something or the other would make them want to die. That reality should not, however, lead to nihilism wrt therapeutic intervention.
Suicidal ideation is highly prevalent among teens but often spontaneously desists; imo the health agency was correct to deny assisted suicide on the grounds she was too young. Still, given the range and severity of Pothoven’s self-harm behaviors, and their resistance to all forms of treatment, sadly it was probably inevitable that this troubled young woman would end her life at some point.
I don’t know. I hate to be skeptical about this case as it seems cruel, but, skepticism is a sadly necessary part of life. When a child dies, the parents are usually the first to be questioned, for example – absolutely gut-wrenching for parents of a child who has just died, but still necessary. And I wouldn’t rule out some form of Munchausen by proxy here. It’s a little strange that she had written a book, was posting about this on social media, and died surrounded by her family. Parents have many ways of using their kids for attention and an impressionable teen might be subconsciously persuaded into thinking of suicide as glamorous or something that would make her ‘famous’ (teens seem to do this at times, not really having the emotional maturity to process the idea that they won’t be around to see their own fame.) Again, I feel cruel saying that, but I do find the way she died a little strange. My own mother would have tied me to a bed and shoved a feeding tube down my throat herself, it’s hard for me to picture a family just watching a 17-year-old die of dehydration without calling for a doctor to put in an IV when she passed out (which she must have, before she died.)
But I understand the bigger question you’re getting at here – is mental illness sometimes so bad that suicide is inevitable. I think the difficult thing about mental illness is that it is such an unstable, unpredictable diagnosis. This is anecdotal, but I have known many people with mental health issues, from the mild to the severe (schizophrenia with paranoid delusions, in more than one case.) Again, anecdotally – it seems to me that people make huge swings in their mental wellness. I’ve seen people who were full on psychotic really turn it around and end up with a job and a relatively happy, if quite supervised, life. I’ve seen people with mild issues that would seem the most treatable really stay at baseline for their whole lives, always suffering with them. I’ve seen people who seemed beyond hope for years and then got new meds, a new living situation, etc., and really turned around. I feel that the very nature of mental illness makes a reliable prognosis very elusive, which complicates the idea of euthanasia. You never know which people would have been living a happy life given a bit more time.
In the hospital, a coma was induced so she could be tube-fed.
In the US, her expressed desire, once home again, to starve herself to death would be an automatic 5150 if heard by or reported to a mandatory responder. So back to the forced tube-feeding. Is 17 the age of majority in the NL? So the parents had no legal right to commit her?
My suspicion is Pothoven would’ve eventually killed herself no matter what. But forcibly preventing a minor from doing so seems the moral approach. Yes, it prolongs her current state of suffering, but is balanced against the potential for a long, happy life. It’s not analogous to an elderly person suffering through the end-stages of a terminal disease, or even a chronically depressed adult.
I mostly agree, except for the idea that she likely would have killed herself no matter what. I find the book / Instagram aspect of this case most troubling… teens do really, really stupid things that seem romantic at the time, especially with a big audience. Besides that, for any situation like this, there’s really no way to know what was going on from afar, without a lot more detail.
I’m also not clear on how or if her final hours were supervised. She was denied medical euthanasia requests, but I would find it extremely troubling if she didn’t have some kind of supervisory outsider with her to confirm that she was the one refusing food and water, right up to the possibly delirious end. Letting parents say “they wanted to die” sets a dangerous precedent, if nothing else. Then again, if she had medical personnel in the house providing palliative care such as painkillers, I do consider that assisting in her suicide (it’s a lot easier to go ahead and die of dehydration while on morphine), so I think there’s a lot more to know about a case as complex as this.
“… do you think euthanasia should ever be allowed for those suffering from mental illness?”
Well, we have a nation with >47,000 suicides in 2017 and the rate is rising. If there were a process, perhaps some could get needed help.
That’s a heckuva good point.
Exactly – the controls needed are, actually, also ways into treatment.
This would be an interesting case study. Who was the first to frame it as a euthenasia story, or imply that she had been euthenized? Track down that person and get them to explain themselves. Was there a deliberate aim to spread misinformation? If so, why? If it could be done, that would be a story worth pursuing.
The headlines were misleading in another way: ‘Rape Victim, 17, Euthanized’ implies an immediate & recent chain of events.
That opens up a whole new field of true-but-deceptive prejudicial headlines.
‘Unmarried mum dies in car crash after smoking marijuana’ – her daughter is now 22, and she last smoked a joint in 2013, and she was not the driver, but we didn’t actually tell a lie, did we?
cr
For the record, you can bypass most News media paywalls by using an “incognito” or “private browsing” window or whatever verbiage your browser uses.
They use a cookie to track how many articles you’ve read within a specific time period. Those private methods don’t transmit a cookie so they don’t know how many articles you’ve already read.
That said obviously if you’re doing it all the time then just subscribe (I have to WaPo and NY Times). But for a one off- meh.
Good tip, thanks. A friend of mine frequently uses “private browsing”, so I’ll ask him to show me how it works.
Without a doubt. Medical/psychiatric experts should be involved to evaluate and explain possibilities and likelihoods of recovery from the condition that’s causing the pain, but ultimately the decision should be left to the individual.
I think we should also work to remove the stigma and dread that surrounds this decision and procedure as well.
My opinion, from lifelong proximity, first-person and otherwise, to very, very severe depression, is that euthanasia should be legal, whether for mental or physical illnesses.
In my experience the kind of people who believe that no-one should be allowed access to euthanasia are also the kind of people who believe the mentally ill need to ‘cheer up’ and that depression is a failure of will.
I have spoken to plenty of people like that, people who essentially don’t believe depression is real. If it’s someone very close to you it’s especially crushing.
And if you grew up being told that you aren’t unhappy you’re just lazy, or selfish, over and over again; every side telling you the same thing, every family authority figure reinforcing it, both the benign authority figures and the hostile ones, so that you’re surrounded by it so totally that it becomes your truth…then by the time your personality has settled into place in your late teens/mid-twenties it’s possible for a person to simply be broken. Broken beyond the point of fixing. No way out.
I have a certain respect for the strength of will it took this woman to make her decision. The people who criticise her do not have the slightest conception of how huge this will have been for her, how much determination it must have taken and just how excruciatingly awful day to day life must have been.
Everyone gets a little depressed or has ‘the blues’, so oftentimes folks don’t comprehend the depth & intensity of clinical depression. As someone with close friends who suffer from it, that realization really hit home.
Yes. My first marriage was destroyed by the clinical depression my wife suffered from.
I have close friends with dysthymia. I was married to a schizophrenic, dated two bipolars, and tried very, very hard to sustain a long-term relationship with a high-functioning borderline. I sure know how to pick ’em!
But seriously, the pain is very intense to both the sufferer and their loved ones. Slowly, slowly, I believe we are inching towards a better understanding of these disorders, and hopefully soon to treatment and healthcare systems that can make positive impacts.
My mother, I and my children have inherited a relatively mild form of depression (compared to the deadly ones suffered by many people). I have considered dying as an option at times when depressed, but always (so far) have managed to believe that I will come out of it still believing that my life is worth living.
As an atheist, I believe it’s the only game in town.
However, we as a family, have experienced the trauma of the suicide of a beloved wife, sister-in-law and aunt. She was Bipolar and
received appropriate treatment for it which, obviously, didn’t work. Being a very considerate person, she chose the kitchen
floor on which she placed a pillow under her head and shot herself (easier to clean up, you know). She put aluminum foil over the kitchen window so no outsider (particularly neighborhood children) could see in. She left a note.
The whole family was shocked, traumatized and felt guilty (the feeling of guilt never goes away). Each of us thought that we should have seen it coming, known how she was feeling and been someone(s) she could talk to about it. None of us knew. No one else can truly know the depths of despair a terminally depressed person ends up in. All of us felt like we let her down by not intuiting or seeing this in her. We felt that we should have.
An option for “Death With Dignity” in this case would have been so much better for her.
And, for us.
So sorry for your troubles and losses, and thank you for relating your experiences.
I’ve had more than my fair share of close exposure to mental illness, and though words often fail, talking about it does make a difference for others and ourselves.
I think that euthanasia and doctor-assisted suicide should be legal.
However, this was a 17-year-old. Though a person that age may think she knows how she always will be, what she will always want, she doesn’t. She barely has a clue. (As I and most of you know from experience.) I’m sure she was suffering badly. I’m not confident a better life wasn’t available for her, though.
The word euthanasia as most often used is a misnomer. As it was in this case. I live in Oregon which has “Death With Dignity”, not doctor assisted suicide, or euthanasia. This sad young woman committed suicide.
I have written before about knowing Oregon’s “Death With Dignity” process first hand, as my husband availed himself of it when he died. He had stage 4 cancer for which he received all treatments available at the time. From April of 2014 to January of 2016, he received various kinds of chemotherapy, radiation, installation of a tube for removing fluid buildup from his abdomen, etc. He was in pain all this time. Being a very intelligent human, interested in everything, he wanted to live as long as possible. But, there came an obvious point when he, and we, had to acknowledge that his pain was too great, all body functions were malfunctioning and the end was near.
In Oregon, after two doctors agree on the competence of the person to choose this option, no one can assist the dying person in drinking the chemicals to terminate life. It has to be done exclusively by the person who wants to die. His death was entirely on his own terms and as peaceful a death as I have ever witnessed. He could stop his suffering on his time table; noone else’s.
I am a true believer in individuals having as much control as possible over their lives and deaths, whether considering mental or physical conditions.
I don’t know at what age a person should be considered mature enough to decide to die without family or governmental intervention. I’ve known many teenagers who are very mature, and “adults” in their mid-thirties who are immature.
I’m very sorry to hear about your husband, but I’m glad he was able to die on his own terms, with dignity, and with those he loved. Everyone should have that right. It’s certainly the choice I would make if I was in his position.
The “Death with Dignity” route takes courage and it would also be my choice.
Unfortunately, it is not available in South Africa, but several committed people are working towards a change of the laws. Many countries and several states in the US have made the necessary and civilised changes to their laws.
All people should have the CHOICE to die with dignity. Our pets have that privilege but, usually, some religious ‘ethic’ prevents us from doing so. One day it will be regarded as barbaric that people had to suffer a prolonged and agonising death – either mental or physical.
Barbiturates, in one form or another are the most widely used for a ‘humane’ and easy death. Unfortunately, the medico-pharmaceutical industry guards the door to over-the-counter sales. They make huge profits on lives which are unnecessarily prolonged – at least in those countries without a state medical system.
We have a long way to go before we can say – “My life, my choice.”
I would wish the best of luck to anyone trying to change the laws to include “Death With Dignity”. A number of U.S. states that followed Oregon’s lead patterned their laws on Oregon’s which are very stringent. I hope that more and more of us can soon make our own decisions about when and how to die if possible. We should treat humans at least as well as we treat our dying animals.
I won’t swear that I’m remembering this correctly, but my memory is that there was only one pharmacy in Portland, OR that would provide the pharmaceutical ingredients for “Death With Dignity”, and it cost over $1000 paid for by us (no coverage through insurances).
Regarding opposition to this kind of assisted suicide being largely composed of the religious:
I was reading a thread on Reddit yesterday about this story (when people still thought it was the original story told by the mainstream media), and, in a subreddit almost exclusively comprised of atheists, nearly everyone was opposed to it. There were various reasons: age; mentally ill people can’t consent; general opposition to euthanasia; general opposition to euthanasia except in cases of terminal illness; etc.
It seems most people just felt it was wrong and couldn’t really articulate why.
Personally, I believe the right to suicide is attached to the right to bodily autonomy. In cases of mental illness, I think that, so long as the person is “sane” (meaning not schizophrenic or in some other way mentally incapacitated to the point that they can’t make coherent decisions), and so long as other avenues have been exhausted and the doctors involved believe it is unlikely that the patient has any further recourse, assisted suicide should be available. I also think there should be a waiting period in such circumstances, to ensure that the patient will not change their mind. Suicidal impulses can come and go, and I think a month is probably a reasonable time to wait.
” I also think there should be a waiting period in such circumstances, to ensure that the patient will not change their mind. Suicidal impulses can come and go, and I think a month is probably a reasonable time to wait.”
Yes, sometimes it passes. Sometimes the feeling that was so overwhelmingly total a few days earlier isn’t there and things seem possible again.
Obviously I would like to think that, in that waiting period, the person in question gets as much help as possible in turning the situation around, intensive, help from every direction. They don’t just get told to come back in a month if they’re still feeling suicidal. I’d add a lol there but it’s not particularly lol-worthy.
Liberals and secularists are probably more open than most to the idea of assisted suicide for incurable physical ailments, but with depression and related problems it’s hard to believe that nothing more could have been done and that that death was the only option.
For what it’s worth, BBC Radio 4’s PM programme pointed out that the “euthanasia” reports were wrong and included a lengthy discussion of relevant policy issues in the Netherlands.
What pisses me off is that the sleazy lying bastards in the ‘pro-life’ movement will use this as more propaganda.
Not that they need any, they’re quite capable of manufacturing more lies out of blank paper.
Should be renamed the ‘pro-screwing-with-everybody-else’s-life’ movement.
Sorry for the rant.
cr
Why? There’s unlikely to be anyone here who disagrees with you in any significant degree.
>>a doctor, a jurist, and an ethics expert<<
Could somebody please explain to me again, what an "ethics expert" is? Is it somebody who can second-guess even a Catholic?
The BBC have now published a report about how the media (including one of their own international outlets) got the story wrong. https://www.bbc.co.uk/news/world-europe-48541233