It was a sunny summer morning when Zoë opened the countdown calendar on her phone. There it was: zero days, seven hours.
Another seven hours. That’s the downside of desperately wanting something: the wait seems to take for ever. To kill some time, she went for a stroll along the canals of Leiden. This will be my last time here, she thought to herself. She sauntered past an organic chip shop, a restaurant and the cafe terrace where she’d had the occasional G&T over the previous few weeks.
It was 19 June 2023 – the day Zoë, who was 22, was allowed to die. Her original choice had been the 18th, for the symbolic significance of the number. With the one, she was putting herself first; with the eight, the infinity sign on its side, she was doing so for all eternity. When the psychiatrist called to say that her euthanasia would be happening a day later, she had an 18 tattooed on her neck.
Zoë crossed the street, back to the hospice where she had spent the past few weeks. A black hearse nosed out of the alleyway leading to the garden. She stopped in her tracks: this hearse was here for her. The coffin was inside the vehicle.
“Would you like to take a look?” asked the funeral director, Evelien.
“Sure,” Zoë whispered.
That’s when she noticed the woman’s T-shirt: “Ook al is alles kut, er is altijd liefde,” it said. “Life sucks, but love rules.”
Evelien pointed to the driver: “She’s got one too.”
“Life sucks” was Zoë’s motto and the T-shirts had been printed specially for today. Zoë herself would be wearing a white dress in her final moments. White, because her life had been dark enough.
Then, finally, it was two o’clock. In her bedroom, Zoë gave everybody a hug: her mother, her younger brother, a friend she had met in the care system and her psychologist Paul. She lay down on the bed, facing the window that she had covered in photos. It was a small collage of happy memories: her first parachute jump, Barcelona with her mum, Zeeland with her gran, the beach with a friend.
Everybody gathered round the bed. Evelien was standing at the head. She had promised Zoë to keep talking to her until after she had been dead a while.
The psychiatrist ran through everything one last time, step by step. “The first injection will numb your vein.”
Zoë was sweating. Her heart was pounding.
“The second will cause your breathing to stop. Death will follow soon after.”
In order to comply with the law around euthanasia, the psychiatrist had to ask one final question: “Are you sure?”
Zoë began to cry, softly at first, but when she saw the syringe the psychiatrist was holding, it turned into sobbing. She was afraid that she would still be conscious when her breathing stopped. Zoë’s mother was crying too.
Zoë went out into the hospice garden to see her younger brother, who had been waiting there for everything to be over. She smoked a cigarette, went for a stroll with the psychiatrist and, with Evelien, listened to the piano music they had selected for the funeral.
At half past three, she messaged all her contacts: “Dear all, I changed my mind at the last minute and won’t be dying today. My apologies for any panic that I may have caused.”
* * *
“Life sucks, that’s all I can say.” Zoë on WhatsApp, 20 June 2023
Zoë lives in the Netherlands, one of three countries in the world where unbearable mental suffering can be grounds for euthanasia. According to figures from the Dutch Regional Euthanasia Review Committees, last year 138 people died by euthanasia for this reason. Twenty-two of these were under the age of 30.
It had taken Zoë four years to persuade her family and her psychiatrist at the Expertisecentrum Euthanasie, or Centre of Expertise on Euthanasia, that she should be allowed to die. Yet at the last minute, she had decided not to go ahead.
The next day, she prised the photos off the window in her bedroom. Now that she no longer planned to die, she had to leave the hospice. But where would she go? She had no idea. Before entering the hospice, she had lived on her own, but she had given notice on her accommodation. Her mother didn’t think it would be a good idea for Zoë to move in with her.
Knowing that she was permitted to die had given Zoë the peace of mind she never thought she’d find. But now the anxiety came hurtling back like a boomerang. She was afraid. Afraid that she wouldn’t be able to pull herself out of this deep hole, but even more afraid of other people’s judgment. What would they make of her U-turn? And what was with the radio silence after her message yesterday?
Zoë had wanted to die because she was unable and unwilling to live with the consequences of childhood traumas. Everyday things such as showering, brushing her teeth, getting dressed and sleeping in her own bed were triggers that brought back the most awful memories, which she then would relive all over again. The nightmares made it all but impossible to sleep and there were times when she lived on fluids because she couldn’t bear solid food in her mouth.
I first met Zoë in the hospice, two weeks before her planned death. Over the next 18 months, we would speak around 40 times and exchange more than 200 messages. But that first day, she hadn’t looked me in the eye, and her voice was small and vulnerable. Every so often she stumbled over her words, owing to the effects of medication. “My life is no life at all, it’s survival,” she told me.
Zoë had finally broken her long silence on the abuse she suffered between the ages of seven and 15. She had never reported it to the police, and nobody had ever been convicted. As a little girl she didn’t have the words, and as a teenager she was deeply ashamed. To take the edge off the mental anguish, and as a form of punishment, she began to inflict physical pain on herself. She cut and burned herself, stopped eating and spiralled into a drink and drug addiction. Anything to forget. It was also a cry for help. She couldn’t raise the issue, but perhaps someone would ask why she was doing all this?
She did open up on one occasion. She was 14 at the time, and receiving treatment for an eating disorder. But the healthcare professional she confided in did nothing, which led Zoë to conclude that what was happening to her wasn’t serious enough. A new truth nestled in her mind: she was worthless, a drama queen, an attention-seeker. And the abuse was her own fault. She could have said no, right? She made a pact with herself: never again would she share what had happened with anyone.
She was bullied in school and given a whole raft of diagnoses by mental health practitioners. Anxiety disorder, anorexia, depression, borderline personality disorder, you name it. These were eventually whittled down to a single diagnosis: complex post-traumatic stress disorder, caused by severe childhood trauma.
All Zoë’s other symptoms stemmed from this, but that hadn’t stopped her from receiving treatment for them for 10 years: cognitive behavioural therapy, creative therapy, schema therapy, family therapy, eye movement desensitisation and reprocessing (EMDR), exercises to improve her self-image, eight different antidepressants and 21 rounds of electroshock therapy. None of it had helped. No wonder, as the underlying trauma hadn’t been addressed. But Zoë didn’t see it that way. She felt like the loser who didn’t respond to treatment, the girl who hadn’t tried hard enough to get better. For fear of disappointing or being disappointed, she pushed away anyone who showed her any kindness. She was lonely.
That was how the idea of wanting to die had begun to take hold. After her first suicide attempt at the age of 15, she was taken to a clinic. She dropped out of school, and was in and out of the clinic, spending more time with therapists than with friends.
On 20 June 2023, while Zoë was stuffing her things into a pink suitcase at the hospice, preparing to leave, she received a call from Paul, the psychologist. He had found her a bed in the emergency department of a psychiatric hospital. She could move in right away.
“No way am I going there,” she said. Paul told her what she already knew but didn’t want to hear: she had no choice. Either she would have to go to the emergency ward, or to a homeless shelter.
* * *
“The situation is more hopeless than ever. I’ve slipped back into self-harm. But I’ve dyed my hair, it’s black now.” Zoë on WhatsApp, 27 July 2023
The clinic where Zoë went after leaving the hospice was like a small village. A labyrinth of low brick buildings, green with damp, at the back of a new housing estate. Right next to it was the hospital. Every time Zoë heard an ambulance, her leg started shaking. She hated the clinic, yet it felt like home too. Having spent so much time in this kind of place, she knew the ropes. She was familiar with the microwave meals and suspended ceilings. And she was familiar with the behaviour that went with it. She hadn’t cut herself for two and a half years, but now she couldn’t resist the temptation. Of all the destructive ways she had come up with to block out the mental pain, cutting worked best. “I’m trying to cut or burn away as much of myself as possible to make space for new, clean skin,” she wrote on a piece of paper. Her room was littered with notes on which she’d scribbled her thoughts.
Stuck to her wardrobe was a piece of white card that says, “Do I really want this?”, which Zoë had carried around with her from place to place since registering with the Centre of Expertise on Euthanasia at the age of 18. She looked at it at least a dozen times a day. Her answer had never felt clearer.
“Everybody was angry when I didn’t die, or else they went away, on holiday,” she told me when I visited her at the clinic in mid-July. “Now I feel more strongly than ever that I have to die, because otherwise everybody will be annoyed.”
Her psychologist Paul later explained to me that people around her had distanced themselves because they didn’t know what to make of their own emotions. But Zoë felt abandoned. She spent whole days in bed to “manage her attacks”. During those attacks, she shook violently and sometimes even lost consciousness. While outwardly resembling epilepsy, the attacks were her body’s way of releasing emotional tension.
The Centre of Expertise told Zoë they were prepared to talk about restarting the euthanasia process. But for this she would need a fixed address, and that might take a while to sort out. She was on a waiting list for supported living accommodation in The Hague. But they would only have her if she stopped cutting herself.
The day prior to the intake interview with the care facility in The Hague, Zoë made sure she stayed out all day, to avoid temptation. She popped into a charity shop, bought an apple turnover at a supermarket and went out for a walk with some staff from the clinic and a friend. But that evening, in her room, she reached breaking point. Her head felt as if it were about to explode. What if they turned her down? Then she wouldn’t be allowed to die. That would be the end of everything. All she wanted to do was was to grab some razor blades and hurt herself.
At one in the morning, drunk on sleep medication, she staggered to A&E, where she received stitches. Again.
* * *
“It’s hard for me to admit, but I had a shower for the first time in four and a half months.” Zoë on WhatsApp, 7 September 2023
“I’d love for them to say, ‘It’s on next week,’ but I know that’s not realistic.” Zoë lit her umpteenth cigarette. It was late September, and Zoë had stayed in the clinic. The psychiatrist from the Centre of Expertise would be visiting later. She was going to reapply for permission to die.
Zoë was dressed in a suit jacket and had painted her nails bright red. “Fake it till you make it,” she said, laughing. I asked whether she was worried that they’d think she was doing well.
“It’s the other way around with me,” Zoë said. “When you see me in a blazer or a shirt, I’m at rock bottom.”
“Why do you think you can go ahead with it now? What has changed?” I asked while we were out walking. She said she was still scared that the injection wouldn’t work properly, because her body was so used to vast quantities of medication. But recent months had been decisive: her life was more hopeless than ever. “I’m still afraid, but I’m more afraid of the life I have to live than I am of death.”
We stared into space. Crows cawed overhead. “I thought you might be able to start over,” I said.
“How?” She shrugged her shoulders. “There’s nowhere for me to go. Nobody will have me. And what am I supposed to do? I never even finished school.” She explained that she had been admitted to the psychiatric unit before her final exams.
This time, she felt, she could go through with euthanasia. She had recently reported the abuse to the police. It wouldn’t go as far as an official statement; for that, she would have to explain in detail what happened, and she couldn’t even do that with a therapist, let alone a police officer she’d only just met. But reporting the abuse felt like something she had to do before she could die.
While Zoë talked to the psychiatrist, I waited in her room at the clinic. She had moved from the emergency department to a regular inpatient ward, but the room was identical: a bed, a wash basin, a desk and a wardrobe.
Stuck next to the note saying “Do I really want this?” was her funeral card, from June. It pictured Zoë standing on the beach in her white dress, the wind in her dark, shoulder-length hair. I looked at her bed, where there was a deflated helium balloon in the shape of a zebra. A gift from another patient on the ward because of the stripy pattern of cuts on Zoë’s arms.
Forty-five minutes later the door opened.
“Well?”
She gave me a hug. “All good,” she said softly. “I need a smoke first.”
* * *
“It’s been agreed that I’m dying on 18 December. It’s an immense relief to me.” Zoë on WhatsApp, 12 October 2023
The euthanasia process was restarted, three months after Zoë was originally scheduled to die. She was back in talks with psychiatrists to prove that her suffering was unbearable. The first time around, those conversations had left her with mixed feelings. It was disconcerting that the psychiatrists confirmed her suffering and didn’t see a future for her, but at the same time it felt like validation.
Like the last time, Zoë intended to remain in therapy until the very end, just to prove that she had done everything she possibly could. She had trauma therapy with Paul twice a week. He had started working with her a year before. They had got off to a difficult start, she told me in October, in the car on the way to see him. “Paul’s a man, and I don’t trust men.”
But gradually, things had changed. Paul didn’t leave. He persevered with the treatment, even though Zoë had supposedly exhausted all treatment options. And finally, she felt able to be completely honest about a particular traumatic incident. It was a first. “If I die without telling anyone, the person who did this to me wins. Being honest about this feels like a personal victory,” she told me.
During the drive to Paul, her legs shook nonstop. Withdrawal symptoms, she said. She was down to 25 milligrams of oxazepam – 20 times less than when we had first met four months before. At her feet lay a tote bag with red hearts on it. Inside was a teddy bear, tissues, lavender oil, stress balls, a scarf for tugging at, and gobstoppers, the sweets she popped into her mouth while she was showering to make sure that she stayed in the “now” and didn’t get hauled back into “then”.
A week later, she sent me a message: “I’m stopping the euthanasia process for now.”
I called her back at once. “It’s great that you’re choosing life,” I said.
That wasn’t how Zoë saw it. She wasn’t choosing life, she just wasn’t choosing death right now.
I asked her: then what is it you’re choosing? It was a difficult question. There’s obviously no such thing as a little bit dead, but Zoë’s world wasn’t black or white at that moment. “I’m a bit grey,” she says.
She meant that she was keeping two options open, life and death. A spokesperson from the Centre of Expertise told me that Zoë’s decision to pause the euthanasia process wasn’t unusual: around 40% of patients who submit a request for euthanasia due to mental suffering end up withdrawing it. The Centre was giving Zoë the space to explore whether she truly wanted to die, and in the meantime she and Paul would figure out whether she would be able to live by working through her traumas.
Our conversation that day stopped and started. Why was she struggling to express herself? “My whole life I’ve been the girl who wanted to die,” she said. “So who am I without my death wish?”
* * *
“With a bit of luck, I can leave here around the middle of January. I’m glad, because I’ve had it with this place, but I’m scared too.” Zoë on WhatsApp, 26 December 2023
By late December, Zoë had been in the clinic for six months. The medical team thought it was time for her to move on: if you want to give life a chance, you can’t stay in a psychiatric hospital. The social worker put in an urgent request for supported living, a form of housing for people under 30 with mental health problems who are unable to live independently but who are too well to stay in an institution. Residents eat communally and can access help if they need it, with the goal of eventually being able to move on and live by themselves.
Thousands of young people in the Netherlands are on the waiting list for this type of accommodation; the waiting time can be as long as two years. So it came as a huge surprise when Zoë was invited for a consultation less than two weeks later. On 15 January 2024, she packed her pink suitcase and left the clinic for a new place in the centre of Rotterdam.
At last she was standing on her own two feet. She took up running, quit smoking and went to the dentist for the first time in three years – a huge personal achievement. On weekends she explored museums with a friend, visited her grandparents and stayed over at her mother’s. Every now and then she had a G&T. If there was ever a moment of hope, this was it.
But it didn’t sit well with Melissa, the best friend she had met while receiving treatment as a teenager. “How’s Esther doing?” Melissa asked when the three of us had lunch together, one Sunday in February. Esther was the ostrich on a postcard Melissa had once sent Zoë. The bird had come to symbolise Zoë’s tendency to bury her head in the sand. Exercising, dressing well, giving up smoking – Melissa thought it was all done because she was trying to avoid something else, something that wasn’t going so well.
“Zoë is good at giving those subtle hints,” Melissa told me. “If you know her well you’re thinking, I bet she’s trying to tell me something.”
Zoë snorted, but she knew her friend had a point.
For a while after halting the second euthanasia process, everything had been coming along nicely. But now she was beginning to feel the weight of expectation. “I’m preoccupied with living up to other people’s expectations. I don’t want to disappoint anybody, as I have a history of doing that,” Zoë said. She whispered: “I’ve reached a point where I want to live, more than anything, except I don’t know how.”
So she was imitating life as she thought it was meant to be. Exercise, family get-togethers, museum visits. Meanwhile, she felt terrible. And instead of asking for help, she did what she always did when the anxiety mounted: self-harm and self-destruction. She would wander the streets for hours on end. On one occasion, when her mother called to ask where she was, Zoë was shocked to find herself beside the railway line. Later, she would say that it hadn’t been because she had wanted to die, but because she’d lost track of where she was and what she was doing.
On 28 February, she reached breaking point. At 9 o’clock that morning, a month and a half after she had left the clinic, her grandparents took her back there.
* * *
“It happens because I’m a master of pretence. People have such high expectations for me so then I start pretending. But there comes a point when I can no longer pull it off …” Zoë on WhatsApp, 4 March 2024
Was she wrong? Was life not her thing after all? Here she was again, back in this godforsaken clinic. Different room, same story. The photos, the notes with the mottoes and the string of fairy lights – after putting them all up again, she spent all day staring at them from her bed. She wanted to hide from everything and everybody, but that’s no easy feat in a psychiatric hospital. “I ha-ha-hate this place,” she sobbed uncontrollably when she bumped into Iris, the body-oriented therapist, in the corridor. The woman wrapped her arms around her and gently rocked her to and fro.
Zoë knew from experience that this I-want-to-get-out-of-here-ASAP phase would last around three days. After that, she would get comfortable and the clinic would start to feel like a kind of community. In a way, that was even scarier. This sense of community was something she didn’t have in the “real” world, where she was expected to look after herself.
How come she couldn’t do that? She asked the ward psychologist why she was finding it so hard to wean herself off the clinic.
“I think you’re yearning to be a child,” was the psychologist’s response.
“I never had the chance to be one,” Zoë whispered.
“And the clinic is the closest you can get to the safety and security that you so crave.”
* * *
“I don’t really know what I’ve been up to these past few days, because I’ve taken too much medication. I needed some peace of mind. But I do remember that I fell flat on my face.” Zoë on WhatsApp, 7 April 2024
Like a seasoned pro, she rolled up her clothes. The trousers and dresses first. The smaller pieces went in the gaps. Zoë was packing her pink suitcase for yet another move. It was now April 2024 and she was heading to Amstelveen, to a clinic for intensive trauma treatment. She had been on the waiting list for 10 months. I had said I would drive her to her mother’s, where she would spend the night before travelling to the treatment clinic the next day.
She heaved the suitcase into the boot of the car. A carer who had come out to say goodbye remarked, “I have the same suitcase for when I go on holiday for a week. But hers contains her whole life.”
The carer gave Zoë a hug. “Bye Mussie.” Little Sparrow.
“There she goes, my little bird,” she said. “A new phase.”
A new phase. I wondered if Zoë saw it that way too. I manoeuvred the car through the buildings on the hospital site. Everything was grey and bleak; threadbare curtains in front of the windows, cigarette butts on the pavement. “This may well be phase one of my recovery,” she said. “Everything was always focused on death before. Now I’m doing it for myself. After that, I’ll see what’s what.”
We stopped at her home in Rotterdam to collect some things. We traipsed up two flights of stairs. The hallway reeked of wet towels and cigarette smoke, but Zoë’s room was fresh and cosy. The walls were covered in photos and bits of paper with mottoes on them. As we were about to leave, she quickly snatched one off the wall. “I decided I could do it all,” it said. She grinned.
Back in the car I asked: “What if you really could do it all?”
“I’d go to Africa,” she said. “To work on a project with children.”
She told me that she would like to study social work, but because she didn’t finish school she’d have to sit an entrance exam. She had already looked up the date. “I’m determined to do that, however low I am.”
But in order to take steps towards the social work course, her trauma symptoms would have to improve. She wanted to be rid of the constant flashbacks and be able to shower, eat and sleep so she could get up when the alarm clock went off and keep appointments. That was what the intensive trauma treatment was for. She said she was apprehensive. “What if it doesn’t work out?”
* * *
“I have four hours of therapy a day. It’s tough, but I wouldn’t want them to plan any less out of pity, because I don’t need pity.” Zoë on WhatsApp, 25 April 2024
A month later, she was back in Rotterdam. “I’m doing OK, actually,” she said when we met for an ice-cream. And that felt weird, because it was something she hadn’t experienced in a long while.
I was trying to work out why she was feeling better. She said the group was nice, that she likes structure and that she had stopped taking benzodiazepines, the anti-anxiety drugs she had long taken by the bucket-load. But more than anything, it was down to the therapeutic breakthroughs: “I brought everything out into the open. Including the things I never talked about before.”
It wasn’t that death had disappeared from her life. She still thought about it almost every day. “When other people think it’s time to walk the dog, I ask myself: do I want to die today?” But death was no longer in the foreground, it sat alongside life.
“I have no regrets about the euthanasia process,” she said. “Having been so close to death, I view life as something valuable. I won’t always be well, but I now know that there’s light at the end of the tunnel.” Zoë’s trajectory reflects research conducted by Rosalie Pronk, who studies euthanasia decisions taken for psychiatric reasons. “When euthanasia is considered a real option and patients feel seen and heard, a death wish can ease and sometimes even disappear entirely,” Pronk told me.
I asked Zoë what gave her hope, and she laughed. “This will sound crazy, but I genuinely enjoy paying rent. It gives meaning to my life, quite simply because it’s something normal.”
“What if you hadn’t been allowed to die?” I asked. “Would you still be here?”
“No,” she said. “It was the one thing that got me out of bed. I had a plan ready in case I didn’t get permission.”
A week after our appointment, she sat the college entrance exam. It wasn’t a success.
“What do you expect?” she messaged. “I missed five years of school!” She told me that she had been nervous and that her mind had gone completely blank. Those five lorazepams the night before probably hadn’t been a good idea, either.
Later that same afternoon she signed up for adult education classes, starting in the autumn. She would finish secondary school first. You can’t build a new life overnight.
* * *
“19 June is getting closer and I’m dreading it. Paul put it nicely: celebrate it like a second birthday, or a first one even. You didn’t ask to be born, but this is the day when you indirectly chose life.” Zoë on WhatsApp, 21 May 2024
On the anniversary of her first euthanasia attempt, Zoë worked through everything on her planned programme. She went for a run, took the train to see Paul – they ate a strawberry tart together, with one candle on it – and then travelled to Leiden, back to the place where she had chosen life the previous year. Along the way, she bought herself flowers. In her bag was a little jar filled with notes. She had come up with a ritual, which had involved asking friends and family for their answers to two questions. How do they see her? And what do they wish for her?
She walked past the organic chip shop and the restaurant, and stopped to have a G&T at the cafe terrace. At the entrance to the alleyway that led to the hospice garden, she hesitated. This was where the hearse had parked last year. Now she was standing here with flowers and a bag full of messages for a new life.
In the hospice garden, where the sun warmed the grass, she lay down the flowers, one by one. For each flower, she read somebody’s message. “Vulnerability is not a weakness,” read one of the notes. Another: “The most beautiful people live complicated lives.”
One window in the building was open, right above her head. I looked at her questioningly, and she nodded. That’s where it had happened, in that room.
A few weeks later, Zoë went on holiday with her family. In September she started adult education classes to study for her school diploma. She still sees Paul for trauma therapy. At her supported living facility, she cooks for her 15 housemates twice a week. She still experiences trauma symptoms and has trouble concentrating. But she’s optimistic. “I survived death, so I’ll survive life as well.”
Zoë’s name has been changed
Translated by Laura Vroomen
In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
