“The night before she died, she actually wanted to sleep alone, in her own bed,” says mother Bianca (53). “I sang lullabies to her with crazy, made-up lyrics. Like before. Later that night she came to me anyway.”
They fell asleep hand in hand. “One last time I could look deep into her beautiful blue eyes, knowing that this was the very last moment I could be so close to her.”
Precious moment
A year and a half after Denise’s death, there are tears when her mother tells about the precious moment at home in Heerenveen.
Tangible memories of the young woman are also in the apartment. The Barbie dolls and cuddly toys that were in bed with her before Denise’s death are in a large open cupboard against the wall. Photo books and her phone are on a shelf. With a pink case, that was her favorite color. And there is an urn with her ashes.
In the room your gaze is automatically drawn to a penetrating black and white photo of Denise. A beautiful girl – with beautiful eyes indeed – looks straight into the lens. Nothing in the picture betrays the terrible, grueling battle that played out every day in her head.
That struggle started when Denise started kindergarten and started interacting more with other children. “Until then she was a very cheerful, funny girl. She was always sensitive to stimuli and she needed a lot of structure, she felt best with that.”
There were many incentives at school. “On her very first day she hit another child on the head with a shovel. It was probably too much for her.”
Out of his mind with anger
Playdates after school? No success either. “She quickly came into conflict with other children, took everything very literally, did not understand jokes. She kept meeting with one girlfriend for a while, but in the end it did not work out. She became increasingly lonely.”
Denise could explode enormously, completely out of her mind with anger. “Panic attacks, we later understood. If she had to learn something new, for example brushing her teeth, it went wrong. Open the tube, put toothpaste on your brush, put the cap back on, brush, rinse. Those are a lot of small steps. She couldn’t process that and then she completely panicked. As a child you are constantly learning new things. So there was also that panic all the time.”
At seven, Denise sat across from her first psychologist. When she was about ten, she renovated her room in the chalet in a blind frenzy during a family holiday. And in group 8, just before the final musical, she had a psychosis for the first time. “All the practice and the idea of a lot of people coming to watch, it was way too much for her.”
Denise was diagnosed with Asperger’s, a form of autism. “Probably also a personality disorder, but we have not had that investigated further.” She went to a special secondary school, but that didn’t calm her mind. On the contrary: “When she was 13, she stood with a knife in front of her 7-year-old sister.”
Again with tears in her eyes, mother Bianca says: “She could no longer live at home, her therapists said. We could no longer risk that with her sister, we understood that too. Terrible, I thought. I thought: who will stop her in bed at night, give her a hug?”
For five years, Denise lived on a care farm where professionals lovingly and skillfully cared for her. But the teenager continued to struggle terribly, with everything really. “At the age of fifteen she made her first suicide attempt. She survived, but broke three vertebrae. She had to walk with a corset for months. She said: I don’t mind that, mom. But that it failed.”
So young, been through so much
Bianca continues: “I remember when we arrived at the hospital, how she lay there in that bed. So young and already been through so much, it broke my heart. Before that moment, it hurt me a lot to see her struggle. But from then on I was also always alert, always on. There was constant fear.”
That fear turned out to be justified, more attempts followed. Crisis shots too. “She always acted out of desperation. She saw people she knew from the past, peers, achieve all kinds of things. While everything she tried herself failed.”
In the summer of 2018 there was that letter, in which the then 18-year-old Denise told her parents and sister that she wanted euthanasia. An option she had discussed at the autism center where she was being treated at the time. “For eleven years I have fought for a life that does not yield me anything. Nothing positive in any case. The only thing of value is you. You should never forget that. I love all three of you infinitely,” it said.
And also: “I hope you can respect my wish and that I can go in a peaceful way.”
Her parents could. Right away actually. The many mandatory crisis admissions, treatments that always seemed to work but could never make a difference in the end, the suicide attempts, the panic and the desperation: it was crystal clear to Bianca and Joost that their daughter wanted to, but couldn’t.
“We had seen her struggle for years. She even took up studies – internally on the care farm – really tried to make something of life. But she didn’t succeed. Now she said: I don’t want to live anymore. How could I can’t accept her decision?”
Denise and her parents turned to the Expertise Center for Euthanasia. To start the process there, Bianca had to send in the reports that the various practitioners had drawn up in previous years about her daughter’s psychiatric problems.
“I walked to the mall with an envelope full of A4s. While the world around me went spinning, all I thought was: this envelope contains the death of my child. Once at the mailbox, my thoughts went: if I I’ll sign her death warrant. Of course it wasn’t really like that, but that’s how it felt. And then….then I let go.”
Bianca sobs. Letting go, the envelope, but especially her daughter. It hurt her so much. “You know, I’ve been looking to myself for a long time, asking myself: is this just me? Am I not responding well to her? But I’ve let go of that too. People sometimes still ask: couldn’t you have tried this, or that? But we did everything and more.”
A few months after sending the files, in November 2018, the center of expertise had a first meeting with an independent psychiatrist. Then, in the spring of 2020, a special care team was appointed to consider Denise’s euthanasia wish.
That team did not happen overnight. “Denise was very young. Then your adolescent brain is not yet fully developed. She was also going to move to another assisted living place during that period. The experts wanted to see that for a few more months: maybe things are going better there?”
But it didn’t go any better this time either. In June 2021 there was the decision of the expertise center. “Denise only had a conversation at first. But we were soon called in. Her doctor asked: will you tell your parents or shall I do it? I got a yes, Denise then said, I can go.” How did that feel? “I was happy for her.”
First a date was set in September 2021. But Denise didn’t want to wait anymore, couldn’t wait anymore. So it became the last week of July. “Then I knew: my child is going to die in four weeks.”
The last two weeks before her death, Denise came back to live at home. Everything that needed to be said was said in those last fourteen days. “She was afraid she had been a bad person, wondered if she could go to heaven. But she’s dancing in heaven now, I’m sure.”
Bianca added: “She was so sweet, so talented. The world was just too big for her, too busy, too complicated.”
In her best clothes
On the afternoon of July 26, Denise de Ruijter passed away at the age of 21. Shortly before, the doctor had given her one last explanation about euthanasia. “Then she sprinted to her bed crying. I’m so glad I can go,” she said.
Bianca and Joost were at her feet when Denise left. “She didn’t want us to be closer to her, couldn’t bear our emotions. Her sister Kirsten wasn’t there, she couldn’t handle it. She fell asleep with her favorite YouTube channel on the earphones of her phone. Between her hugs and with her best clothes.”
Those cuddly toys and that telephone are still in the closet in the living room, with the photo and the urn. Denise’s mother keeps many more memories in her head and heart. “We used to dance together when she was little. She’d jump into my arms, wrap her legs around me and we’d swing cheek to cheek across the room.” Tears. “I try to meditate daily. While I do that, I sometimes relive those moments. Then it’s like she’s with me again.”
Kind of happy
How is Bianca doing now? For a while she was unable to work. Recently she has a new job, in the library in the city. She beams when she shows the name tag she wears during her shifts: “It’s really nice there!”
Of course it doesn’t make Denise’s loss any less. That’s always there. “I have a huge hole in my heart. But I do feel – kind of – happy. It’s nice to be able to live again, I haven’t been able to do that for a long time.”
Moreover, Denise asked her mother to make memories that she could no longer make herself. “So I do.” And after a short silence: “I think life is very beautiful. It is given to me to be able to feel that. Then I have to make something of it.”
Fellowship Foundation
Bianca is committed to the new foundation Let Go In Love. Parents who lost a child to euthanasia or whose child is in the process of euthanasia can go there. “Sharing feelings is possible, but also asking practical questions. I want them to feel seen and understood, that there may be openness.”
Euthanasia due to psychological suffering is not common at Denise’s age. It Center of Expertise Euthanasia received a total of 868 requests for euthanasia from people who could no longer handle it psychologically in 2021, the year Denise died. Ten percent of that was granted, the center indicates. Less than ten of the patients who received a ‘yes’ because of mental distress were between the ages of 18 and 30.
The total number of people who die from euthanasia is much higher. Euthanasia does not always go through the center of expertise. All cases must be reported in the Netherlands to the Regional Euthanasia Review Committees. Last year’s figures are not yet known, but in 2021 a total of 7666 people died from euthanasia. In 115 cases, the reason was psychological suffering, 14 of which involved someone younger than 30 years old.
For questions about euthanasia, please contact the Knowledge Center Euthanasia. Is Bianca’s story recognizable to you and do you want to talk about it? For peer contact here justifiably.
