Mrs Cassandra Radford1, Mr Andrew Wiley1
1South Australian Prison Health Services, Adelaide, Australia
Biography:
Cassandra Radford is a Nurse Consultant with SA Prison Health Service and holds a Master of Nursing in Custodial Health and Primary Health Care. She has extensive experience and a passion for supporting complex health needs of people in custody, recognising that high‑quality care reduces recidivism and promotes community reintegration.
Andrew Wiley, Registered Nurse and the Director of SA Prison Health Service, providing primary healthcare across South Australia’s prisons. With 15 years in justice health in SA and Victoria, he is actively engaged in national and international networks focused on advancing health outcomes and equity of care for incarcerated populations.
Abstract:
Introduction/Background:
People in custody experience high rates of chronic and life‑limiting illness, yet access to end‑of‑life care is complicated by systemic barriers of security versus health. The principle of equivalence of care aims that those in custody receive the same standard of palliative care as the community. Voluntary Assisted Dying (VAD) is one end‑of‑life option, but it cannot be delivered without strong, concurrent palliative care pathways. In South Australia (S.A), partnership with Palliative Care Services has been critical for patient support, goals‑of‑care discussions, and symptom management. The experience of three VAD cases in custody—the first in Australia—illustrates the complexity of delivering VAD in correctional environments and highlights the essential role of palliative care in supporting these processes.
Deaths in Custody in South Australia/Aim:
SA has a death in custody rate which is almost double the national average and whilst VAD contributes to this number, the majority of deaths remain natural, highlighting the importance of robust palliative care in correctional health. Collaborative pathways with Central Adelaide Palliative Care Service strengthen the ability of correctional health teams to deliver holistic end‑of‑life care, whether through palliative care alone or alongside VAD.
Lessons Learnt/Results:
Autonomy—the right to make decisions about one’s own life and death—is central to person‑centred care and regarded by many as a fundamental human right. Yet for people in custody, autonomy is inherently restricted. The challenge for healthcare providers is to support patient choice within these limits, ensuring dignity at end of life. South Australia’s three VAD cases required coordination between VAD teams, corrections, prison health and palliative services. Patient preferences around the location of death are shaped by complex influences, including estranged family relationships and the need for familiarity and trust within the prison health environment.
Conclusion:
The South Australian experience shows that VAD in prisons cannot exist without high‑quality palliative care and hopes to inform and support other prison jurisdictions. Upholding autonomy and equivalence of care requires embedding VAD within strong palliative frameworks that respect dignity, choice, and person‑centred end‑of‑life care for vulnerable populations.