‘My 33-year-old anorexic daughter died by euthanasia – my husband and I stood by her’

Anorexia has the highest mortality rate of any psychiatric illness, from medical complications as a result of the disease and from suicide. Research suggests that just 46 per cent of anorexia patients recover fully – and some 20 per cent remain chronically ill.

Dutch guidelines for administering euthanasia for psychiatric illness are more stringent than those for physical illness, though many argue that they are not strict enough. In addition to a consultation with a doctor specially trained to assess euthanasia requests, the opinion of an independent psychiatrist is required.

A significant majority of these cases also involve the Euthanasia Expertise Centre in The Hague, a last chance saloon that takes patients who have been denied euthanasia by their physician (and indeed, many Dutch medics oppose it for mental illness).

Most of those who receive euthanasia for a psychiatric condition are women. Minors can also request it from the age of 12, but require parental permission until 16. Surprisingly, 16- and 17-year-olds don’t need explicit parental permission, though their parents must be ‘involved in the decision-making process’.

After Esther reapplied, Ellen drove her to see a psychiatrist called Menno Oosterhoff. In a book Oosterhoff has written along with pro-euthanasia psychiatrist Kit Vanmechelen, informed by excerpts from Esther’s diaries, he admits it is difficult to determine whether a ‘death wish’ is the symptom of debilitating mental illness or, in fact, a logical consequence of an illness. And, he asks, if a death wish is regarded as a symptom, what if it is impossible to treat? This ethical quagmire deters many mental health professionals in the Netherlands from even discussing it.

Ellen can still remember the appointment with Oosterhoff. ‘[He] read about Esther’s many years of illness, and he said to her, “The worst thing I can say to you now is that I have some options to make you better. I don’t have any options, Esther.”’ He concluded that Esther was sound of mind and determined to die.

This time, her request was approved. Ellen felt only relief for her daughter.

The period that followed was the ‘most beautiful’ of Esther’s illness, Ellen recalls. She made a calendar of those six weeks for Esther to fill with people she wanted to see and other things she wanted to do, but it remained empty. ‘She wanted to stay at home.’

She moved back in with her parents, and every morning she would wake early, smoke a cigarette, then lie on their bed with them. They walked, drank coffee, watched feel-good Christmas movies, laughed together and talked and talked. ‘In six weeks, we said everything,’ says Ellen. ‘We held her, we said we loved each other, we said, “Esther, it’s OK.”’