Sandra Sarantou, an Adelaide woman preparing to die tomorrow using voluntary assisted dying, is urging the prime minister to change the Commonwealth Criminal Code so regional Australians can more easily access the care. The law, written far from the people it controls, has left some Australians effectively denied access because of where they live. That’s the machinery at work. Not a medical question alone, but a legal chokehold on who gets to choose how they die.
Who Gets Stuck With the Bill
Nine weeks ago, the 58-year-old was diagnosed with the same aggressive lung cancer her father died from. Medication is no longer effective for her nerve pain, nausea and dizziness. She said she was "grateful" to be ending her life on her terms after watching her father endure a long and painful death before voluntary assisted dying was legal around the country. But she also said she was shocked to learn a provision in the Commonwealth Criminal Code means some Australians are effectively denied access because of where they live.
"It's even a struggle just to move from one end from the house to another … for those people to travel hours to possibly see a doctor and not get the chance for VAD is just horrific," she told ABC News. That’s the hierarchy in plain sight: people already weakened by illness are the ones expected to absorb the cost of distance, travel, and bureaucratic design.
VAD is legal in every Australian jurisdiction except the Northern Territory, which is expected to pass legislation allowing it this month. But state laws that allow telehealth for some discussions about VAD have run into the Commonwealth Criminal Code, which was intended to outlaw the use of "carriage services" to "incite suicide" and has been interpreted to apply to doctors advising patients about VAD. The result is blunt. Doctors cannot use phone, email, internet or video to advise patients about accessing VAD medication.
What the System Forbids
Workforce shortages in rural and remote areas have meant some dying people have been forced to travel long distances to make those appointments, and some have missed out because travel was not possible. The rules don’t just sit on paper. They land on the sick, the isolated, and the exhausted.
Federal Independent Kate Chaney today introduced a private members bill to have the Commonwealth Criminal Code amended. Greens Senator Sarah Hanson Young will introduce a similar bill to the Upper House this month. Without government support, both bills may languish. That’s the familiar parliamentary trap: a problem is identified, a bill is filed, and the same institutions that created the barrier get to decide whether to move it or leave it in the drawer.
There is also a push within Labor's rank and file for change. Last month, delegates to Labor's National Conference voted to amend the party's platform, supporting the use of telehealth for end-of-life care. Delegates also enshrined a commitment to give Labor MPs and senators a conscience vote on all VAD issues. But the party machine still has its gatekeepers. Labor sources have said Prime Minister Anthony Albanese remains personally opposed to allowing telehealth for VAD, and his opposition may prove crucial to the fate of any legislative change.
He supports voluntary assisted dying but has argued face-to-face consultations are an important way to ensure vulnerable patients are not taken advantage of. Attorney-General Michelle Rowland has also expressed reservations and raised concerns about the risk of elder abuse if telehealth was allowed. Several Labor MPs have told the ABC they are confident the law will eventually change but that it will require more time and conversations to convince the prime minister.
What People on the Ground Are Doing
Ms Sarantou, who worked as a paramedic for 13 years and treated patients in rural areas, felt "guilty" she could access VAD while others could not. "Their time is ticking and they have to suffer. It's cruel, it's not fair," she said. "Please change these laws, make it fair and available for everyone despite where they are living."
Advocacy group Go Gentle's latest "State of VAD report" suggested there was strong demand for the care outside cities, with 39 per cent of applicants in 2024-25 living in rural, regional and remote areas. The numbers cut through the polite language. People outside the cities want access, and the system keeps making them jump through more hoops.
General practitioner Scott Lewis has travelled 3,000 kilometres across South Australia in the past fortnight alone to see people seeking voluntary assisted dying. Dr Lewis, who flies his own plane to reach rural patients, said he saw about two new VAD patients a week. He said workforce shortages and the lack of Medicare funding were preventing more rural doctors from offering VAD care. "[Rural and remote] doctors are so busy as it is, that they simply haven't had the time or thought to extend their practice into voluntary assisted dying," he said. "I don't make much money from it, to be blunt."
He told ABC News he had experienced "a sense of failure" knowing patients have missed out on VAD due to their isolation. "To see the hurt in family members who've had to see their loved ones suffer and … come so close to being approved for voluntary assisted dying but not quite get there … it's hard at times."
Sydney University Law Health expert Dr Christopher Rudge said he believed telehealth could be allowed without weakening overall protections. "Across the country the states have very rigorous and documented process for permitting someone to undergo a VAD procedure, and all of those would apply whether it's by telehealth or any other circumstance," he said. "My understanding is that the telehealth communications would occur at an early stage of the process but that at some stage, the witnessing and some other processes, would presumably need to occur in an environment where doctors are present."
Under state laws, people applying for VAD must have been diagnosed with a terminal illness and facing death within a year. They must attend face-to-face medical appointments so that two independent, trained practitioners can assess whether they are eligible, acting voluntarily and capable of making their own decisions. The patient must provide a written request for VAD, which has to be witnessed by independent adults, not family members. A co-ordinating practitioner makes a final declaration and a state board or oversight body provides final approval.
Dr Rudge said he was "sympathetic" with concerns that telehealth could replace face-to-face consults, but did not think that would be a consequence of changes to the Commonwealth Criminal Code. "In circumstances where informed consent is not clear, the in-person consultation is the best place for those questions to be answered. And so, I can understand why people could be concerned," he said.
For Sandra Sarantou, the hardest part of preparing for VAD is knowing that she has to say goodbye to her son. But she said they had been "completely open" about the VAD process and had found comfort in black humour. "We had the idea to put my ashes into a big party cracker … and then everybody has got a bit of my ashes," Ms Sarantou laughed. "But it is hard. It is emotional at times. But we just try to make the best out of it."