Sandra Sarantou, an Adelaide woman, will die tomorrow using voluntary assisted dying, but not before spending her final hours lobbying the prime minister. She seeks to change a Commonwealth Criminal Code provision that effectively denies regional Australians equitable access to end-of-life care. Nine weeks ago, the 58-year-old received a diagnosis of the same aggressive lung cancer that killed her father; medication no longer controls her nerve pain, nausea, and dizziness.
Ms Sarantou, who witnessed her father's prolonged and painful death before voluntary assisted dying (VAD) became legal, expressed gratitude for her own choice. Yet, she feels "guilty" knowing others in rural and remote areas face systemic barriers. She told ABC News that for those already struggling to move, "to travel hours to possibly see a doctor and not get the chance for VAD is just horrific." This legal framework, enforced by the state, creates a two-tiered system of access based on geography and economic capacity, favoring those in urban centers.
State-Imposed Barriers
A provision in the Commonwealth Criminal Code, originally intended to outlaw the use of "carriage services" to "incite suicide," has been interpreted by the state to override state laws that allow telehealth for VAD discussions. This interpretation means doctors cannot use phone, email, internet, or video to advise patients about accessing VAD medication. While VAD is legal in every Australian jurisdiction except the Northern Territory, which expects to pass legislation this month, the Commonwealth provision effectively nullifies state efforts to expand access.
Prime Minister Anthony Albanese remains personally opposed to allowing telehealth for VAD. His stance may prove crucial to the fate of any legislative change. He argues 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, raising concerns about the risk of elder abuse if telehealth were allowed. These official positions from the state's highest offices maintain the current restrictions, despite expert opinions suggesting otherwise. The state prioritizes its interpretation of risk over the material conditions of its citizens.
Healthcare for Profit, Not People
The state's legal framework exacerbates existing structural inequalities in healthcare provision. Workforce shortages in rural and remote areas mean dying people are forced to travel long distances for appointments. Some miss out entirely when travel becomes impossible. General practitioner Scott Lewis, who flies his own plane 3,000 kilometres across South Australia in a fortnight alone to see VAD patients, highlights the economic disincentives within the system. Dr. Lewis sees about two new VAD patients a week but states, "I don't make much money from it, to be blunt." He attributes the lack of rural doctors offering VAD care to existing workloads and a "lack of Medicare funding," which fails to adequately compensate practitioners for this specialized service. This systemic underfunding ensures that essential care remains inaccessible where it isn't profitable for providers, demonstrating capital's logic at work.
Dr. Lewis has experienced "a sense of failure" knowing patients have missed out on VAD due to their isolation. He describes 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." Advocacy group Go Gentle's latest "State of VAD report" for 2024-25 indicates strong demand outside cities, with 39 per cent of applicants living in rural, regional, and remote areas. This underscores the widespread impact of these systemic failures on the working class and dispossessed.
Limits of Reform
Federal Independent Kate Chaney today introduced a private members bill to amend the Commonwealth Criminal Code. Greens Senator Sarah Hanson Young is set to introduce a similar bill this month. However, without government support, both bills "may languish," demonstrating the limits of reform efforts when opposed by the state's executive power. 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 commitment to a conscience vote for Labor MPs and senators on VAD issues. Yet, the Prime Minister's personal opposition casts a long shadow over these internal party reforms, revealing how individual power within the state can override collective party decisions.
Sydney University Law Health expert Dr Christopher Rudge believes telehealth could be allowed without weakening overall protections. He notes that states already have "very rigorous and documented process for permitting someone to undergo a VAD procedure." He acknowledges concerns about informed consent but suggests telehealth would occur at an early stage, with in-person consultations still required for witnessing and other processes. For Ms Sarantou, a former paramedic who treated patients in rural areas for 13 years, the situation is clear: "Their time is ticking and they have to suffer. It's cruel, it's not fair." She pleads, "Please change these laws, make it fair and available for everyone despite where they are living." Her plea highlights the human cost of the state's inaction.