LONDON (NYTIMES) - By the time she was 17, the Dutch teenager had written a harrowing memoir recounting repeated sexual assaults and her subsequent experience with post-traumatic stress disorder, depression and anorexia.
Last year, when she was 16, she approached an end-of-life clinic in the Netherlands seeking euthanasia or assisted suicide but was rejected because her parents had been unaware of her request and she needed their permission, according to a local newspaper profile published in December.
On Sunday (June 2), when her sister announced that the teenager, Noa Pothoven, had died at 17 on Sunday morning - without revealing where or how - the story ricocheted and metastasised around the globe.
It spurred an outpouring of condolences on social media and set off debates about the nature of the Dutch law on euthanasia and the spread of misinformation.
In the initial absence of detailed information from medical officials or from Pothoven's family, the Internet was flooded with inaccurate reports that she had died via legal euthanasia, raising questions about how someone so young could be allowed to die voluntarily.
But the teenager did not die of euthanasia, according to her family, the Dutch health minister and the Royal Dutch Medical Association. She had stopped eating and drinking, her relatives said in a statement, and she was at home in the eastern Netherlands when she died, Dutch news outlets reported.
Steven Pleiter, director of the end-of-life clinic in The Hague that Pothoven approached last year to help end her life, would not go into details about her case because of privacy reasons, but he said by phone on Wednesday: "It is a terrible story of a young woman who made the decision to end her life."
"It would be fake news if we made this euthanasia," he added.
The story of the Dutch teenage author from the city of Arnhem appeared even to have caught the attention of the Pope, who alluded to the case on Wednesday in a Twitter post. "Euthanasia and assisted suicide are a defeat for all," his account tweeted.
But as Pothoven's case became a battleground for arguments about the right to die, many commentators criticised news outlets in Europe and the United States for wrongly reporting the means of her death. Naomi O'Leary, a journalist with Politico, initially debunked those stories in a post on Twitter.
Pothoven's case, as tragic as it is, turned out to be far more complex than initially reported. The health minister, Hugo de Jonge, said in a statement on Wednesday: "There is no question of euthanasia in this case." He was speaking based on information from the family, with whom the authorities were in touch.
According to a private Instagram post written in Dutch by Isa Pothoven, her sister, who allowed The New York Times to see it, Noa Pothoven died at 2:40am Sunday local time. "You deserve a lot better, but Noa, go to sleep," Isa Pothoven wrote. "We will have to let go of you."
Noa Pothoven's family told Dutch news outlets in a statement on Thursday that she had stopped taking food and had been under the supervision of a medical team. Subsequent news reports said that Pothoven had died at home in her living room in Arnhem.
Isa Pothoven did not respond to follow-up questions, and other members of the family could not be reached for comment on Thursday.
Active euthanasia - when a doctor injects a lethal combination of drugs into a patient - and assisted suicide - when a doctor provides the means for someone to take his or her life - were legalised in the Netherlands in 2002.
It is legal for someone as young as 12 to request and receive euthanasia, as long as the parents give their permission, according to Dutch law. For those 16 to 18, parents must be aware of the request, but their permission is not necessary, Pleiter said.
Pothoven unsuccessfully tried to end her life more than once, according to the newspaper profile in December. Pothoven said in an interview at that time that she longed for peace and the absence of pain.
Her mother, Lisette, also said in an interview with a Dutch newspaper in December: "Noa doesn't want this life anymore." She added, "She just longs for peace."
In her autobiography, Pothoven wrote that at the age of 11, she was sexually assaulted at a school party. The next year, she was assaulted again at a classmate's party. At 14, she was raped by two men.
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She did not tell anyone for a long time, she wrote, but the experience took a destructive toll. She recounted in her book, Winning Or Learning, which was released in November, that she suffered from post-traumatic stress disorder, depression and anorexia.
"To this day, my body still feels dirty," the teenager wrote. "My house has been broken into, my body, that can never be undone."
In an Instagram post last week that was subsequently deleted, Pothoven announced that she had stopped eating and drinking, a local newspaper reported on Monday.
"After years of fighting and fighting, it is finished," she was quoted as saying. "After many conversations and assessments, it was decided that I will be released because my suffering is unbearable."
Pleiter, director of the end-of-life clinic in The Hague, said that gaining approval for euthanasia was a complex process. After the clinic receives a request, he said, it is reviewed, with doctors and nurses making home visits and conducting multiple interviews.
Every person seeking euthanasia must meet criteria set by Dutch law, which include ensuring that the request is voluntary, that the person is in unbearable suffering with a poor prognosis that shows no improvement, and that he or she is mentally able to understand the process and its consequences.
From the moment a request is made, it typically takes four to six weeks for the request to be processed in the case of physical illnesses. But when it comes to mental illnesses, things are more complicated.
"It is complex to decide if they meet the criteria," Pleiter said.
The clinic received 2,600 euthanasia requests in 2018 - 27 per cent to 28 per cent of them were from mentally ill patients, according to Pleiter. Of the 727 patients who were euthanised last year, about 50 were patients with mental health problems, he said.
After O'Leary, the Politico journalist, wrote a Twitter thread criticising the misleading news coverage, Euronews, a network based in France and one of the first English-language websites to report the story inaccurately, issued a correction. Other prominent news outlets also removed the claim that she had died via euthanasia.