Choice Without Access Is Not Equitable Choice
Reflections on VADCON 2026 – A Rural Nurse's Perspective
by Fiona Antony | Registered Nurse and Director, Florence at Home | Portland, Victoria
Attending VADCON 2026 was an incredibly valuable experience, both professionally and personally. Over two days, I had the opportunity to listen, learn and reflect alongside people who share a commitment to improving dignity, autonomy and choice at the end of life.
I returned to Portland feeling inspired, challenged and more determined than ever to advocate for equitable end-of-life care, particularly for people living in rural and regional Australia.
As a community aged and palliative care nurse, I have spent many years supporting people living with advanced illness, frailty and complex healthcare needs. I have witnessed the extraordinary resilience of individuals and families, but also the difficulties they face when trying to navigate a healthcare system that does not always reflect their needs or wishes.
For me, VADCON reinforced a fundamental question: What does genuine choice mean if the services and support needed to exercise that choice are not accessible?
Day One – Choice, dignity and the reality of access
The first day challenged me to think more deeply about autonomy, dignity and what it truly means to provide person-centred care.
We frequently speak about respecting individual choice, yet having a legal right to make a decision does not necessarily mean a person has the opportunity, knowledge or support to exercise that right.
Discussions around prognostication, frailty, multimorbidity and dementia highlighted the complexities of end-of-life decision-making. Not everyone experiences a predictable disease trajectory, and for those living with multiple chronic conditions or progressive cognitive decline, determining prognosis and eligibility can be particularly challenging.
One discussion that resonated strongly with me was the concept of intellectual humility.
As healthcare professionals, we bring clinical knowledge, education and experience to our practice. However, we must recognise that we are not the experts in another person's lived experience.
We cannot presume to know what constitutes an acceptable quality of life for someone else, nor should our personal beliefs determine the choices available to them.
Our responsibility is to listen with curiosity, provide accurate information and support individuals to make informed decisions that reflect their own values and wishes.
The discussions around stigma, conscientious objection and institutional barriers were equally thought-provoking.
Respecting a person's choice requires more than acknowledging their wishes. It requires us to recognise the barriers that may prevent those wishes from being heard, understood or acted upon.
Day Two – Turning principles into meaningful care
The second day built on these themes, focusing on how we translate principles of dignity, autonomy and equity into practical healthcare delivery.
I was particularly interested in the discussions around dementia and decision-making capacity.
Dementia is not a single, uniform condition. Individuals experience cognitive decline differently, and the relationship between capacity, prognosis and VAD eligibility raises significant ethical and clinical questions.
These discussions reinforced the importance of recognising the individual beyond their diagnosis, while acknowledging the legal safeguards and complexities surrounding voluntary assisted dying.
Another highlight was learning about a coordinated VAD service model in Sydney, where nurses play an important role in supporting assessments, maintaining continuity of care and advocating for patients throughout the process.
This prompted me to consider what a similar coordinated approach could mean for rural Victoria.
For people living in communities such as Portland, access to authorised practitioners and specialist services can involve considerable travel, delays and additional emotional and financial burdens.
Telehealth was another significant area of interest. Although Commonwealth legislation places restrictions on certain VAD-related communications, I believe we must continue exploring lawful ways to improve access to specialist support for rural Australians.
Geography should not become an additional barrier to informed healthcare decisions.
The relationship between palliative care and voluntary assisted dying was another important discussion.
While these remain distinct pathways, I strongly believe that a person's decision to explore VAD should never result in the withdrawal of compassionate, high-quality palliative care.
Regardless of the choices a person makes, our commitment to their comfort, dignity and wellbeing must remain unchanged.
What I am taking back to rural Victoria
Perhaps the greatest value of attending VADCON was the opportunity to reflect on what these discussions mean for the people and families I support every day.
Through Florence at Home, an RN-led, GP-supported community nursing service in Portland, I am working to develop a model of care that places the individual, rather than the healthcare system, at the centre of decision-making.
Our approach recognises that people are more than their diagnoses, medical histories or care requirements.
They are individuals with their own values, relationships, beliefs, fears and hopes for the future.
For some, their greatest wish is to remain safely at home as they become increasingly frail. For others, it may be to avoid further hospital admissions, discontinue burdensome treatment or focus entirely on comfort and quality of life.
For some, it may involve exploring their legal options around voluntary assisted dying.
The role of person-centred healthcare is not to determine which choice is right for someone, but to ensure their voice remains central to the care they receive.
Working in rural Victoria, I see how workforce shortages, geographical distance, fragmented services, limited health literacy and inadequate coordination can affect people's ability to access care.
I also recognise that those experiencing the greatest disadvantage are not always in a position to advocate for themselves.
Some people have limited family support. Others experience cognitive or communication difficulties, social isolation or uncertainty about their rights. Some simply do not know what services or choices may be available to them.
These are the voices I believe we have a responsibility to hear.
VADCON strengthened my commitment to advocating for people whose experiences and wishes may otherwise be overlooked.
It also reinforced the importance of collaboration between GPs, community nurses, specialist palliative care teams, VAD care navigators and other healthcare professionals.
No single service can meet every person's needs. However, by working collaboratively, communicating effectively and respecting the individual's wishes, we can reduce fragmentation and create a more responsive and compassionate healthcare system.
Through Florence at Home, I want to continue strengthening these relationships, improving education, identifying barriers to care and contributing to meaningful, measurable improvements in how community-based healthcare is delivered.
I believe nurses have an important role in this work.
We are often the healthcare professionals who spend time with people in their own homes, listening to their concerns, understanding their circumstances and supporting them through some of life's most difficult decisions.
This provides us with a unique opportunity, and responsibility, to recognise when someone's voice is not being heard and to advocate for change.
My overall reflection – Choice must mean something
I left VADCON 2026 feeling inspired by the dedication of those working to improve end-of-life choice across Australia, but also challenged by how much work remains.
We have made significant progress in recognising the importance of autonomy and individual choice at the end of life.
However, legislation alone cannot guarantee equity.
If a person cannot access appropriate information, healthcare professionals, services or support, then their ability to exercise that choice may be significantly limited.
What stayed with me most throughout the conference was the importance of listening.
Not simply hearing what someone says, but genuinely understanding what matters to them, what they fear, what they hope for and how they wish to live the time they have remaining.
As nurses, we are privileged to be invited into people's homes and lives, often during their most vulnerable moments.
We see the person beyond the clinical presentation. We understand the challenges families face, the importance of familiar surroundings and the significance of seemingly small choices that can make an enormous difference to someone's quality of life.
These experiences continually remind me that dignity is not something we provide to people. It is something we must recognise, respect and protect.
I believe the future of equitable end-of-life care requires more than legislative reform. It requires education, genuine collaboration, accessible community-based services and a willingness to listen to those whose experiences are too often absent from healthcare discussions.
It also requires us to challenge the assumption that everyone has the same opportunity to access care simply because that care exists.
My commitment following VADCON is to continue advocating for rural communities, strengthening person-centred models of care and ensuring that people who are vulnerable, isolated or underrepresented are not forgotten in conversations about healthcare reform.
Advocating for voluntary assisted dying does not mean believing it is the right choice for everyone.
It means respecting that each individual has their own understanding of dignity, suffering and quality of life, and supporting their right to receive accurate information, compassionate care and access to lawful choices.
My greatest takeaway from VADCON 2026 is that choice without access is not equitable choice.
For those of us working in rural healthcare, recognising that inequity is only the beginning. We must be prepared to listen, ask difficult questions, challenge barriers and advocate for meaningful change.
Because ultimately, a person's dignity, autonomy and right to be heard should never be determined by their postcode, diagnosis, circumstances or ability to advocate for themselves.
And that is the commitment I bring home to Portland.
Fiona was chosen by the DWDV Board to receive a sponsored ticket to VADCON26.
