At just 17-years-old, Dutch teenager Noa Pothoven had already written an award-winning memoir detailing her struggle with post-traumatic stress disorder, depression and anorexia in the wake of sexual assault and rape.

In her autobiography, Pothoven wrote that she had nothing left to live for.

At 16, she approached the Levenseinde, or “end-of-life,” clinic in The Hague to inquire about euthanasia, but, according to an interview last year with local newspaper the Gelderlander, her request was rejected.

Last week, after years of battling mental illness, Pothoven announced on Instagram that she had begun refusing all food and liquids.

“After years of fighting, the fighting has finished. I have now stopped eating and drinking for a while, and after many conversations and reviews it has been decided that I will be released because my suffering is unbearable,” Pothoven wrote in a post, which has since been removed.

“I have not really been alive for so long, I am surviving, and not even that. I am still breathing but I am no longer alive.”

On Sunday, Dutch media reported that Pothoven had died in a hospital bed in her family’s home in Arnhem after she stopped eating and drinking.

But, in the hours and days that followed, a barrage of international media reports falsely suggested that Pothoven had been “legally euthanized.”

It was a sensationalist version of an already tragic story that swiftly spread across the globe, triggering an emotive debate over the ethics of euthanasia and raising questions over how someone so young could be allowed to die that way.

Pothoven had not been euthanized, according to her family, who issued this statement in the Gelderlander: “Noa had chosen not to eat and drink anymore. We would like to emphasize that this was the cause of her death. She died in our presence last Sunday. We kindly ask everyone to respect our privacy so we as a family can mourn.”

The Levenseinde clinic, the Royal Dutch Medical Association and the Dutch health minister also denied that Pothoven died by euthanasia.

“Despite international media reports to the contrary, there is no question of euthanasia in this case,” Dutch Minister of Health Hugo de Jonge said in a statement. “Questions about her death and the care she has received are understandable, but can only be answered once the facts have been established.”

So why did so many media outlets get it wrong?

Media’s misreporting

Much has already been written about the failure of the media to do its due diligence in telling Pothoven’s story.

Politico Europe reporter Naomi O’Leary, one of the first English-language journalists to get the facts straight, laid out the details of Pothoven’s case in a Twitter thread on Wednesday.

“A 17-year-old rape victim was NOT euthanised in the Netherlands” O’Leary tweeted. “It took me about 10 mins to check with the reporter who wrote the original Dutch story.”

After she called out the outlets who had misreported the story, many began to tweak headlines and change copy, some without issuing corrections.

According to a Dutch news report, many British news outlets were initially alerted to the story by Central European News (CEN), a newswire service that specializes in foreign tabloid stories. CEN has previously been accused of providing unreliable information to clients, an accusation CEN fervently denies.

Michael Leidig, who runs the agency, told CNN that when it became clear CEN’s original report mischaracterized Pothoven’s death, they published a new story describing the way she ended her life as a “legal gray zone.”

But Dyck Bosscher, a spokesman for the Dutch Voluntary Termination of Life Association (NVVE), which established Levenseinde, the end-of-life clinic where Pothoven sought out assisted suicide, said this case was clear-cut — she did not die by euthanasia.

“There is a lot of misunderstanding about our legislation around euthanasia,” Bosscher told CNN. “The media reports make it seem as if it is easy to get euthanasia in the Netherlands, but it’s not the truth.”

In the Netherlands, euthanasia and assisted suicide are strictly defined as “the active termination of life at a patient’s voluntary and well-informed request,” according to the Royal Dutch Medical Association; both were legalized in the country in 2002. According to Dutch law, patients as young as 12 may request and receive euthanasia with parental consent. For those age 16 and 17, parents must be aware of the request.

Bosscher explained that gaining approval was a complex, lengthy process under the criteria set out by Dutch law. Over the course of multiple interviews, those seeking euthanasia must convince a doctor that their request is voluntary, they are suffering unbearably, have exhausted all alternative options and are capable of understanding the weight of their decision, he said.

And, in cases like Pothoven’s, when the patient is living with mental illness, the application is even more difficult, because the burden of proof is so high.

Of the patients who are approved to receive euthanasia by the Levenseinde clinic, only 9% are psychiatric patients. The rest are living with cancer or another disease.

Last December, Pothoven told Dutch newspaper the Gelderlander that she was devastated to be denied euthanasia by the clinic. “They are of the opinion that I am too young to die. They believe I need to receive trauma focused treatment first and wait until my brain is fully developed. That won’t happen until I am 21. I am devastated because I cannot wait that long,” she said.

Ethics of euthanasia

While inaccurate reports about Pothoven’s death spread from Australia to the United States, the story also fueled a long-running debate over the ethics of euthanasia — particularly in Italy.

#NoaPothoven began trending on Italian Twitter and even grabbed the attention of the Pope, who appeared to refer to the case in a subtweet.

“Euthanasia and assisted suicide are a defeat for all,” Pope Francis posted on Twitter. “We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope.”

And after major Italian outlets like la Repubblica, Corriere della Sera, ANSA and AGI misreported that Pothaven was euthanised, far-right politician Giorgia Meloni of the Brothers of Italy party declared that Pothoven’s death was “a defeat of an entire civilization that has stopped defending life.”

It was only after Italian politician Marco Cappato, a former member of European Parliament who has campaigned for legal euthanasia in Italy, cited local Dutch media to debunk the reports, that some Italian media outlets issued a correction.

Bioethicists say confusion around the definition of euthanasia helps fuel misinformation.

“There is genuine confusion about what constitutes euthanasia and it’s quite tempting to conflate it with the withdrawal of treatment,” Iain Brassington, a bioethicist and senior lecturer at the University of Manchester in northern England, told CNN. “What’s crucial is the intention.”

Brassington, whose research centers on autonomy and euthanasia, said reporting on assisted dying can quickly become emotive and polarized.

Those two things together — polarizing content that elicits an emotional response — are key ingredients in the spread of misinformation.

And the consequences of false reporting in places like Italy can have wide-ranging effects on passing end-of-life care legislation elsewhere.

NVVE’s spokesman Dyck Bosscher told CNN, in Italy false stories like this regarding euthanasia serve to, “warn people that they should never have this liberal legislation … to underline that this is a slippery slope.”

But Philip Nitschke, an Australian activist and founder of the pro-euthanasia group Exit International, said that while the false story was being touted by the religious right, and others who are against euthanasia, it had also provided a rare opportunity to discuss the issue on a global level.

“What you see is a whole spectrum of opinions from those who believe it is never right to give away your life, and I imagine the Pope falls into that category, through to those who see it as a human right, to be able to decide when and how to give away your life,” Nitschke, whose offices are based in Amsterdam, told CNN.

“It’s quite a good thing to open up the debate.”