Sandra Sarantou will die tomorrow using voluntary assisted dying, but she's spending her final hours urging Prime Minister Anthony Albanese to change a federal law that's blocking rural Australians from accessing the same care she received in Adelaide.
The 58-year-old was diagnosed nine weeks ago with aggressive lung cancer. Medication no longer controls her nerve pain, nausea and dizziness. Yet she considers herself fortunate compared to dying Australians in remote areas who can't reach VAD doctors because federal law prohibits telehealth consultations.
The Federal Barrier
VAD is legal in 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 Commonwealth Criminal Code provision designed to outlaw using "carriage services" to "incite suicide" has been interpreted to apply to doctors advising patients about VAD.
That interpretation overrides state provisions. Doctors can't use phone, email, internet or video to advise patients about accessing VAD medication. They must meet face-to-face.
Workforce shortages in rural and remote areas force some dying people to travel long distances for appointments. Some can't make the journey. They've missed out entirely. Families of people who wanted VAD but died before completing the process say telehealth consultations could have spared unnecessary suffering.
The Political Divide
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 rank and file for change. Last month, delegates to Labor's National Conference voted to amend the party's platform, supporting telehealth use 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 say Albanese remains personally opposed to allowing telehealth for VAD. His opposition may prove crucial to any legislative change. He supports voluntary assisted dying but argues face-to-face consultations are important to ensure vulnerable patients aren't taken advantage of. Attorney-General Michelle Rowland has expressed reservations too, raising concerns about elder abuse risk if telehealth was allowed.
Rural Demand and Doctor Shortages
Advocacy group Go Gentle's latest "State of VAD report" found strong demand for the care outside cities. Thirty-nine percent of applicants in 2024-25 lived 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 flies his own plane to reach rural patients. He sees about two new VAD patients weekly.
He 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."
Dr Lewis told ABC News he'd experienced "a sense of failure" knowing patients have missed out on VAD 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," he said.
Legal Expert's View
Sydney University Law Health expert Dr Christopher Rudge said he believes 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 said telehealth communications would occur at an early stage but witnessing and some other processes would presumably need to occur where doctors are present. He's "sympathetic" with concerns that telehealth could replace face-to-face consults but doesn't think that would be a consequence of changes to the Commonwealth Criminal Code.
Ms Sarantou, who worked as a paramedic for 13 years and treated patients in rural areas, said she feels "guilty" she can access VAD while others can't. "It is 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 said. "Their time is ticking and they have to suffer. It's cruel, it's not fair."
She's planning an unconventional memorial. "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 highlights the tension between federal safeguards and state-level implementation of end-of-life care. The Commonwealth's blanket prohibition on telehealth for VAD consultations creates a two-tiered system where access depends on geography rather than eligibility. Rural Australians face genuine barriers that urban residents don't encounter. Yet Albanese's concerns about protecting vulnerable patients from coercion reflect legitimate questions about how to balance access with safeguards. The lack of Medicare funding for VAD services means market mechanisms aren't filling the gap, and doctors like Lewis are subsidizing rural access themselves. With state laws already containing rigorous approval processes, the question becomes whether federal law should override state frameworks that already include multiple physician assessments and waiting periods. The outcome will determine whether dying Australians in remote areas receive equal treatment under laws their states have passed.