In October 2023, 17-year-old Milou Verhoof died by assisted suicide in the Netherlands following years of PTSD and eating disorders. Her case has sparked a fierce debate across Europe regarding palliative psychiatry, the limits of medical intervention, and whether a state’s duty to protect vulnerable youth is being replaced by a right to give up.
Milou Verhoof was 17. That is the age when most children are looking at university brochures or planning their first real trip away from home. For Milou, the future wasn’t an open door; it was a barrier of pain she could no longer see through.
She wasn’t just a figure in a Dutch health report. She was a girl whose childhood ended early after a brutal sexual assault, followed by a family tragedy when her brother fell seriously ill. Do the arithmetic of what a single heart is expected to carry. Her medical file was a list of prisons: PTSD, life-threatening eating disorders, autism, and OCD.
I write about this because mental collapse is rarely a sudden event. It is a systemic wearing down of a person over years. It is what policy feels like when the soul is wounded deeper than the body. Milou was a child whose world broke long before she asked for the legal right to leave it.
The weight of the invisible
In October 2023, psychiatrist Menno Oosterhoff performed the procedure that ended Milou’s life. It wasn’t a snap decision. Under Dutch law, this step is only taken when every possible treatment has been exhausted and the suffering is deemed unbearable.
Oosterhoff argues a point that many find provocative: mental pain can be just as agonizing as terminal physical illness. When a body is consumed by cancer, we call ending the pain mercy. But when the mind is broken, society often demands an endless, fruitlessly brave endurance.
Science backs the weight of this pain. Research shows that emotional distress activates the same regions of the brain as physical trauma. A broken heart is a literal, biological event. But because we cannot put a bandage on a memory, we struggle to weigh the gravity of the suffering.
A system at its limit
When a 17-year-old has spent her formative years in hospitals and therapies without a flicker of light at the end of the tunnel, survival becomes a job. Eventually, some people simply run out of the resources to keep doing that work. Oosterhoff’s role was to admit that medicine cannot always fix what is broken.
But the system is not in agreement. While Oosterhoff saw an end to suffering, 14 other psychiatrists filed a formal protest. They questioned whether a teenager, struggling with such heavy diagnoses, has the cognitive capacity to make a final, permanent decision about her life.
This is where individual rights crash into the state’s duty to protect life. It is where policy turns into a question of surrender. Critics argue that the system failed to protect a minor, moving toward a "palliative" solution when they should have kept fighting for her.
The view from the kitchen table
The 2025 documentary Milou’s Battle Continues brought this debate into living rooms across the Baltics. In Estonia, the conversation has been sharp. We are seeing a clash between the liberal ideal of self-determination and the fear of a "culture of death" that might eventually target the poor or the neurodivergent because they are "too expensive" to treat.
That is the fear that hits closest to home. We talk about mental health as a priority in the EU, but we know the reality. For many families, the cost of a private specialist is nearly a week’s groceries. If we do not fund the therapy, is providing an exit door a choice, or is it just a cheaper policy?
Do the arithmetic. If we have a shortage of therapists but a legal path to assisted death, we are failing the stress test of a decent society. Palliative care should mean a support system that catches people long before they reach the breaking point.
I write so that we remember that mental health isn’t a luxury; it is survival math. Milou’s story shows us that fixing the system isn’t just about budgets. It’s about the stubborn, practical will to keep the door open for those who have lost their way in the dark. We owe it to our children to make sure they never have to choose between a bill they can’t pay and a life they can’t bear.