Correction: An earlier report stated Noa Pothoven's death came via euthanasia, which she had initially requested. That article has been removed from the Herald's website. The Dutch Health Ministry said Wednesday that Noa's family was maintaining euthanasia had not occurred while indicating the circumstances of her death were still being investigated.
A Dutch teenager who suffered from depression, post-traumatic stress disorder and anorexia after being raped as a child has died at her home, her sister confirmed on Sunday.
In what she termed a "sad last post" on Instagram, Noa Pothoven, 17, wrote Saturday that she would be dead within 10 days. But it had been "so long," she added, since she had "really been alive".
"After years of struggling and fighting, it's over," she wrote.
The teenager, from the city of Arnhem in the eastern part of the Netherlands, said she had stopped eating and drinking and would soon be "released because my suffering is unbearable".
Her decision was not "impulsive," she emphasised. Rather, it was the result of "many conversations and assessments".
Offering her own blunt review of her condition, she observed, "I survive, and not even that. I breathe but no longer live."
It was unclear whether her death had come with the involvement of doctors, whose assistance she had at one point requested.
In a statement to the Washington Post on Wednesday, Hugo de Jonge, the Dutch Minister of Health, Welfare and Sport, said her family had indicated that, "there is no question of euthanasia in this case".
"Questions about her death and the care she has received are understandable, but can only be answered once the facts have been established.
"I have asked the Health and Youth Care Inspectorate to look into this."
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."
Assisted suicide is legal in parts of Europe and the United States, although rules differ about the degree to which a third party may actively carry out the patient's death.
Active euthanasia, as it is known, is lawful in only a handful of countries, including Belgium, Luxembourg and the Netherlands.
The Netherlands became the first country to legalise the practice, in legislation passed in 2001, the year Noa was born. The vote in the Dutch parliament was the culmination of a campaign that began in 1973, following the prosecution of a general practitioner who had ended the life of her mother after a cerebral haemorrhage left her partly paralysed, deaf and mostly unable to speak.
However, the approval of the legislation was also marked by impassioned protest from Christian groups.
A crowd of at least 5000 people, many of them children, undertook a silent march to register their objection as lawmakers considered the measure.
Under the law, euthanasia by doctors is permitted only in cases of "hopeless and unbearable" suffering.
The End of Life Clinic in The Hague, where Noa had sought services, spells out the narrow circumstances under which doctors "may provide assisted dying, requiring that "the patient makes a clear and autonomous request and is enduring unbearable and unendurable suffering".
There must be no other reasonable solution, and patients have to demonstrate understanding of the "consequences of what they are requesting".
Doctors are required to seek counsel from an "independent colleague, who is not familiar with the patient".
Children as young as 12 can seek euthanasia under Dutch law, but those 12 to 16 must obtain parental consent.
In 2014, Belgium became the first country to legalise euthanasia for children.
The procedure accounted for less than 4.4 per cent of all deaths in the Netherlands in 2017, according to a report from a review committee.
Of the 6585 requests that were granted, most were in cases of untreatable cancer. Only a small number involved psychiatric distress. The process is carried out by an attending physician who administers a lethal dose of a "suitable drug", according to Dutch guidelines.
Noa initially approached the clinic last year, without her parents' knowledge, but was turned away. She was told that she was too young, according to a 2018 profile of her in the Dutch newspaper De Gelderlander.
"They think I'm too young to die," said Noa, who was 16 at the time, explaining how she had been instructed to complete a trauma treatment and wait until her brain was more fully developed.
She lamented the decision, saying, "I can't wait that long."
A spokeswoman for the clinic did not return a request for comment.
Noa's trials are detailed in an award-winning autobiography released last year, titled Winning or Learning. According to her parents, who were frantically searching for new treatments for their daughter, the book should be "mandatory" for social workers and other authorities responsible for youth care.
In her book, Noa traces the origins of her mental anguish. At the age of 11, she was assaulted at a school party — and again at a gathering of teenagers a year later. When she was 14, she writes, she was raped by two men in the Elderveld neighbourhood of Arnhem.
For years, she kept the violations secret, out of shame. It was only years later that her family learned what she had endured, after her mother came across a cache of letters saying goodbye to her loved ones.
She remained too afraid to make a formal declaration to the police.
"I can't," the teenager said.
Lisa Westerveld, a Dutch lawmaker who had visited Noa before her death, when she was surrounded by family and friends in her living room, said she was struck by the teenager's strength.
She told De Gelderlander that it was "nice to see her again," although the circumstances were "surreal".
A spokeswoman for Westerveld told the Washington Post that she did not know more about the circumstances of the teenager's death.
"I will never forget her," the lawmaker vowed. "We will continue her struggle."
The health minister struck a similar tone, saying, "our hearts go out to her family and friends".
"The family must now be allowed to grieve for Noa in peace," he added.
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• The Word
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• CASPER Suicide Prevention
If it is an emergency and you feel like you or someone else is at risk, call 111.