In her final hours before choosing to end her life through voluntary assisted dying (VAD), 58-year-old Sandra Sarantou is directing a powerful final message to Australia's political leaders. The former South Australian paramedic is pleading for an urgent change to federal laws that currently block rural and remote patients from accessing crucial end-of-life consultations via telehealth.

Nine weeks ago, Sarantou was diagnosed with aggressive lung cancer—the very same disease that claimed her father’s life in an era before voluntary assisted dying was legally available. Now, with medication no longer relieving her severe nerve pain, nausea, and dizziness, Sarantou says she is deeply grateful to have the option to die on her own terms. However, she was horrified to discover that a quirk in federal legislation effectively cuts off the same access for other terminally ill Australians simply based on where they live.

"It is a struggle for me just to move from one room of the house to another," Sarantou said. "For people in regional areas to have to travel hours just to see a doctor to access VAD, when they are at their weakest, is absolutely horrific. It's cruel, and it's not fair."

The Federal Conflict Blocking Remote Care

While voluntary assisted dying is legal in every Australian state, and soon to be legislated in the Northern Territory, a major roadblock remains at the federal level. A legacy provision in the Commonwealth Criminal Code, originally designed to prevent online incitement of suicide, makes it a federal crime to use "carriage services"—such as phone calls, emails, internet, or video conferencing—to discuss suicide.

Because the federal law overrides state legislation, doctors are legally barred from using telehealth to consult with patients regarding VAD. For patients living in regional Australia, where severe medical workforce shortages are already common, this legal barrier forces individuals to endure exhausting, painful long-distance travel to secure face-to-face appointments. Tragically, some pass away in pain before they can complete the mandatory in-person assessments.

A Growing Political Push for Change

The push to amend the federal law is reaching a boiling point in Canberra. Federal Independent MP Kate Chaney is spearheading a private member's bill to amend the Commonwealth Criminal Code, while Greens Senator Sarah Hanson-Young plans to introduce a matching bill in the Senate.

Pressure is also mounting from within the Labor Party itself. At a recent National Conference, delegates voted to update the party platform to support telehealth for end-of-life care, also guaranteeing Labor politicians a conscience vote on the matter.

However, the proposed changes face a significant hurdle. Prime Minister Anthony Albanese remains personally opposed to allowing telehealth for VAD, arguing that face-to-face consultations are essential to protect vulnerable patients from potential coercion. Attorney-General Michelle Rowland has also raised concerns regarding the risk of elder abuse.

The Equity Gap in Regional Australia

For medical professionals working on the front line, the current laws present an ongoing ethical struggle. According to advocates, nearly 40 per cent of VAD applicants live in regional, rural, or remote communities.

Dr. Scott Lewis, a general practitioner who flies his own light aircraft to reach remote patients across South Australia, describes the situation as a massive equity issue. Dr. Lewis sees several new VAD patients every week and says rural doctors are too overstretched to take on the intensive travel required for VAD assessments.

"To see the hurt in family members who have watched their loved ones suffer, coming so close to being approved but not quite getting there because of distance, is incredibly hard," Dr. Lewis said, adding that he has felt a deep "sense of failure" when isolation prevents patients from receiving care.

Maintaining Safeguards Through Telehealth

Some legal experts argue that telehealth can be safely integrated without weakening the strict safeguards built into state VAD laws. Dr. Christopher Rudge, a health law expert at the University of Sydney, points out that state-level frameworks are already exceptionally rigorous.

Under current state laws, a patient must be diagnosed with a terminal illness, expected to die within a year, and undergo separate assessments by two independent, trained medical practitioners. They must also submit a written request witnessed by independent adults before final approval is granted by a state oversight body.

"My understanding is that telehealth communications would occur at an early stage of the process," Dr. Rudge explained. "The final witnessing and other critical processes would still occur in an environment where doctors are physically present. In circumstances where informed consent is unclear, the in-person consultation remains the best option, but that shouldn't lock out those who desperately need remote access."

A Legacy of Dignity and Laughter

Before her scheduled VAD procedure, Sandra Sarantou hosted a gathering with close friends to celebrate her life. While she acknowledges that saying goodbye to her son is the hardest part of the process, she has chosen to face her final moments with openness and a touch of dark humor.

"We actually had the idea to put some of my ashes into a giant party popper so everyone gets a little piece of me," she laughed. "It is highly emotional, but we are trying to make the best of it. My final hope is that the government listens and makes this system fair for everyone, no matter where they live."