• Charles Sturt University researchers are contributing to the first comprehensive mapping about how people in rural and remote communities can or cannot access voluntary assisted dying
• Rural and remote communities face unique and often overlooked barriers in end‑of‑life care

Charles Sturt University research has identified key issues relating to voluntary assisted dying (VAD) access in rural and remote contexts.

The study’s four co-authors are nursing academics in the Charles Sturt School of Nursing, Paramedicine and Healthcare Sciences in Dubbo and Port Macquarie NSW.

Their paper, ‘Implementing assisted dying in rural and remote Australia and comparable jurisdictions: A scoping review’, is published in the journal Death Studies (2026).

According to Go Gentle Australia, VAD deaths make up between one to three per cent of all deaths in Australia annually. Most people who choose VAD are between 70 and 79 years old, with cancer the most common reason people request VAD.

Lead author Ms Melissa Hanson said this is the first comprehensive mapping of global evidence on how people in rural and remote communities experience access to VAD.

“This work matters because voluntary assisted dying is now legislated across all Australian states and the Australian Capital Territory, except the Northern Territory, yet rural and remote communities continue to face disproportionate challenges in accessing safe, timely and compassionate care,” Ms Hanson said.

She said the research found that assisted dying presents unique challenges in rural and remote communities, where geographic isolation, cultural norms and service limitations shape access and experience.

“Many of the research articles reviewed call for legislative amendments that clarify legal uncertainties, align state and federal laws, and remove barriers, such as those relating to telehealth that impede equitable access for patients, particularly those in rural and remote areas,” Ms Hanson said.

“Innovative models such as nurse practitioner inclusion, care navigation and culturally safe outreach offer potential solutions.”

The study synthesised peer-reviewed and non-academic literature (reports, etc.) from Australia and comparable jurisdictions, primarily Canada, and one study from India. It identified five key themes relating to assisted dying implementation in rural and remote contexts:

• legislative and policy frameworks
• cultural, social and ethical considerations
• access and equity in service provision
• healthcare provider roles and experiences, and
• family and community impact.

Ms Hanson explained that the review reveals that access is not simply a matter of eligibility but of equity.

“Access is shaped by geography, culture, infrastructure and the relational dynamics that define small communities,” she said.

“Families and clinicians alike carry disproportionate burdens, navigating grief, stigma and systemic barriers in pursuit of compassionate choice.

“To honour the intent of assisted dying legislation, reforms must go beyond legal clarification. The reforms must invest in culturally safe care, telehealth access, expanded provider roles and adapted bereavement support.”

Ms Hanson noted that little is known about the experiences of First Nations peoples, culturally and linguistically diverse communities, and migrant populations in rural areas.

“These represent a critical gap in culturally safe implementation,” she said.

“Only through coordinated, inclusive, and community-informed action can Australia and the world move toward an assisted dying system that is not only lawful but truly just, where dignity at the end of life is a lived reality for all, regardless of location or geographic setting.”