Sandra Sarantou has nine weeks left to live, and she's spending her final days fighting for Australians who don't have what she does: the chance to die on their own terms. The 58-year-old Adelaide woman, diagnosed with aggressive lung cancer nine weeks ago, will use voluntary assisted dying tomorrow. But she's shocked that federal law effectively denies the same care to countless Australians in regional areas.
"For those people to travel hours to possibly see a doctor and not get the chance for VAD is just horrific," Sarantou told ABC News. She's watched her father endure a long, painful death before VAD became legal. Now she's grateful for the choice he never had. And she's angry that geography still determines who gets it.
The Federal Barrier
VAD is legal across every Australian jurisdiction except the Northern Territory, which expects to pass enabling legislation this month. State laws permit telehealth for some VAD discussions, particularly for patients too ill to travel or living remotely. But a provision in the Commonwealth Criminal Code overrides those state protections. Originally intended to outlaw using "carriage services" to "incite suicide," it's been interpreted to prevent doctors from advising patients about VAD via phone, email, internet, or video.
That interpretation has forced dying people in rural and remote areas to travel long distances for mandatory appointments. Some haven't made it. Workforce shortages mean VAD-trained doctors are scarce outside cities, and the lack of Medicare funding discourages more from offering the care.
General practitioner Scott Lewis has flown his own plane 3,000 kilometres across South Australia in the past fortnight alone to reach VAD patients. He sees about two new patients weekly. "I don't make much money from it, to be blunt," Lewis said. He's experienced "a sense of failure" knowing patients have missed out due to 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."
Political Roadblocks
Federal Independent Kate Chaney introduced a private members bill today to amend the Commonwealth Criminal Code. Greens Senator Sarah Hanson Young will introduce a similar bill to the Upper House this month. Without government support, both may languish.
There's pressure within Labor itself. Last month, delegates to Labor's National Conference voted to amend the party's platform, supporting telehealth for end-of-life care and enshrining a conscience vote on all VAD issues for MPs and senators. But Labor sources say Prime Minister Anthony Albanese remains personally opposed to allowing telehealth for VAD. He supports voluntary assisted dying generally but argues face-to-face consultations protect vulnerable patients from being taken advantage of. Attorney-General Michelle Rowland has raised concerns about elder abuse if telehealth were allowed.
Several Labor MPs told the ABC they're confident the law will eventually change, but it'll require more time and conversations to convince the prime minister.
The Human Cost
Sarantou worked as a paramedic for 13 years, treating patients in rural areas. She feels "guilty" she can access VAD while others can't. Medication no longer controls her nerve pain, nausea, and dizziness. It's a struggle to move from one end of the house to the other. "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" found 39 per cent of applicants in 2024-25 lived in rural, regional, and remote areas. Demand is there. Access isn't.
Sydney University Law Health expert Dr Christopher Rudge said telehealth could be allowed without weakening 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. Generally, state laws require terminal diagnosis with death expected within a year, face-to-face assessments by two independent trained practitioners, written requests witnessed by independent adults, and final approval from a state oversight body. Rudge believes telehealth would occur early in the process, with witnessing and other safeguards still requiring doctors' physical presence.
He's "sympathetic" to concerns that telehealth could replace face-to-face consults but doesn't think changing the Commonwealth Criminal Code would cause that. "In circumstances where informed consent is not clear, the in-person consultation is the best place for those questions to be answered," he said.
For Sarantou, the hardest part is saying goodbye to her son. They've been "completely open" about the VAD process and 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," she laughed. "But it is hard. It is emotional at times. But we just try to make the best out of it."
Why This Matters:
The Commonwealth Criminal Code's outdated interpretation creates a two-tier system where Australians' ability to access end-of-life care depends on their postcode. Nearly 40 per cent of VAD applicants live outside cities, but federal law prevents doctors from using telehealth to advise them, forcing terminally ill people to travel hours for appointments many can't physically make. State governments have built rigorous safeguard systems that include mandatory face-to-face assessments, independent witnesses, and oversight boards. The federal barrier doesn't add protection — it just adds suffering. With workforce shortages already limiting rural healthcare and Medicare funding gaps discouraging doctors from offering VAD services, the current law means some Australians die in pain they could have avoided. Sandra Sarantou's final advocacy highlights a fundamental question of equity: should geography determine who gets to die with dignity?