Sandra Sarantou will die tomorrow using voluntary assisted dying, but she's spending her final hours fighting for Australians who can't access the same choice. The 58-year-old Adelaide woman, diagnosed nine weeks ago with aggressive lung cancer, says a Commonwealth law is denying rural patients the end-of-life care available to those in cities.
The barrier isn't state legislation. VAD is legal in every Australian jurisdiction except the Northern Territory, which is expected to pass enabling laws this month. The problem lies in a provision of the Commonwealth Criminal Code that outlaws using "carriage services" to "incite suicide." That provision has been interpreted to prevent doctors from advising patients about VAD via phone, email, internet or video, overriding state laws that permit telehealth for these consultations.
Who Bears the Burden
Ms Sarantou, who worked as a paramedic for 13 years treating patients in rural areas, said she feels "guilty" she can access VAD while others cannot. "It's even a struggle just to move from one end from the house to another," she said. "For those people to travel hours to possibly see a doctor and not get the chance for VAD is just horrific."
Workforce shortages in rural and remote areas have forced some dying people to travel long distances for appointments that must be conducted face-to-face. Some haven't made it. Families of people who wanted VAD but died before completing the process say telehealth consultations could have spared them unnecessary suffering.
Advocacy group Go Gentle's latest "State of VAD report" found strong demand 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, sees about two new VAD patients weekly.
The Medical Reality
Dr Lewis said workforce shortages and lack of Medicare funding prevent 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's 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," he told ABC News.
Ms Sarantou said medication is no longer effective for her nerve pain, nausea and dizziness. She's "grateful" to be ending her life on her terms after watching her father endure a long and painful death before VAD was legal around the country. "Their time is ticking and they have to suffer," she said of rural patients. "It's cruel, it's not fair."
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 bills may languish.
There's pressure within Labor's own ranks 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 Prime Minister Anthony Albanese remains personally opposed to allowing telehealth for VAD, according to Labor sources. 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.
Expert Assessment
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.
Dr Rudge noted 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." He 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.
Ms Sarantou's final message was direct: "Please change these laws, make it fair and available for everyone despite where they are living." She and her family are trying to make the best of her final hours. "We had the idea to put my ashes into a big party cracker … and then everybody has got a bit of my ashes," she said. "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 profound inequality in Australia's healthcare system: where you live determines whether you can access legal end-of-life care. While VAD is legal across the country, a federal law intended to prevent suicide incitement is being interpreted in ways that override state provisions designed to help rural patients. The result is a two-tiered system where urban Australians can access care their rural counterparts cannot, despite facing the same terminal diagnoses and suffering. With 39 per cent of VAD applicants living outside cities, this isn't a marginal issue. It's a question of whether public policy will adapt to ensure equal access to legal healthcare, or whether geography will continue to determine who suffers and who doesn't. The political resistance, even as Labor's own membership votes for change, suggests institutional barriers can persist even when the human cost is clear and the solution is available.