Sandra Sarantou, a 58-year-old Adelaide woman diagnosed with aggressive lung cancer nine weeks ago, is spending her final days urging Prime Minister Anthony Albanese to remove a federal barrier that's denying rural Australians access to voluntary assisted dying. She'll use VAD tomorrow.
The Commonwealth Criminal Code contains a provision originally intended to outlaw using "carriage services" to "incite suicide." It's now being interpreted to prevent doctors from using phone, email, internet or video to advise patients about accessing VAD medication. That interpretation overrides state laws that allow telehealth for some VAD discussions, particularly where patients are too ill to travel or live remotely.
The Federal Roadblock
VAD is legal in every Australian jurisdiction except the Northern Territory, which is expected to pass legislation allowing it this month. States have built rigorous safeguards into their laws. Generally, people applying must have been diagnosed with a terminal illness and be facing death within a year. They must attend face-to-face medical appointments so two independent, trained practitioners can assess whether they're eligible, acting voluntarily and capable of making their own decisions.
But the federal code's restriction means doctors can't use telecommunications for any part of the process. Workforce shortages in rural and remote areas have forced some dying people to travel long distances to make those appointments. Some have missed out because travel wasn't possible.
Ms Sarantou, who worked as a paramedic for 13 years and treated patients in rural areas, said she felt "guilty" she could access VAD while others couldn't. "Their time is ticking and they have to suffer. It's cruel, it's not fair," she told ABC News. "Please change these laws, make it fair and available for everyone despite where they are living."
Legislative Efforts and Labor's Resistance
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 bills may languish.
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 Labor sources have said Prime Minister 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 aren't 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're confident the law will eventually change but that it'll require more time and conversations to convince the prime minister.
The Rural Reality
Advocacy group Go Gentle's latest "State of VAD report" suggested there's strong demand for the care outside cities, with 39 per cent of applicants in 2024-25 living in rural, regional and remote areas.
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'd 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."
Legal Expert Weighs In
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."
Dr Rudge said he was "sympathetic" with concerns that telehealth could replace face-to-face consults, but didn't 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.
Ms Sarantou was diagnosed with the same aggressive lung cancer her father died from. Medication is no longer effective for her nerve pain, nausea and dizziness. Having watched her father endure a long and painful death before voluntary assisted dying was legal around the country, she said she was "grateful" to be ending her life on her terms.
For her, the hardest part of preparing for VAD is knowing that she has to say goodbye to her son. But she said they'd 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."
Why This Matters:
This case exposes a fundamental tension between federal oversight and state-based healthcare delivery. States have already built comprehensive safeguards into their VAD laws, requiring two independent practitioners, written requests witnessed by non-family members, and final approval from oversight bodies. The federal code's blanket prohibition on telecommunications doesn't add meaningful protection—it simply creates geographic inequality. Rural Australians already face workforce shortages and limited Medicare funding for specialized care. Forcing dying patients to travel hundreds of kilometres for consultations that could occur via secure video undermines the principle that access to legal medical services shouldn't depend on your postcode. The prime minister's concerns about elder abuse are legitimate, but they should be addressed through the existing state-level safeguards and in-person requirements for critical steps like witnessing and final declarations—not by categorically banning all telecommunications. Thirty-nine per cent of VAD applicants live outside cities. They're being denied equal access to a legal service their states have approved.