Most of us know, in the abstract, that a person can be young and terminally ill. We understand it the way we understand most terrible things that haven’t happened to us: as a fact we hold at arm’s length, something that belongs to other people, somewhere else. And then a story arrives that refuses that distance. A 26-year-old woman. A decade without food. Twenty-five rounds of sepsis. A body that has been shutting down, system by system, since she was a child. And a decision, finally, that she is ready to choose how and when it ends.
Terminal illness does not keep to a schedule and does not arrive only at the end of long lives. For most of us, early adulthood means ordinary anxieties: career decisions that feel monumental but probably aren’t, relationships we’re not sure about, a vague sense that real life is still somewhere just ahead. For some people, early adulthood means hospital rooms and pain medication and getting through each day only to do it again tomorrow. For those people, the question of voluntary assisted dying is not theoretical. It is an option they might actually need.
Annie Holland, a 26-year-old woman from Adelaide, South Australia, is one of those people. She has known since she was 22 that she was dying. After years of a body that has fought her at every turn, she received approval for voluntary assisted dying and cried, not from grief, but from happiness. The approval meant she had control over something. Possibly the first thing in her adult life she could truly say was hers to choose.
The Condition Nobody Could Name
Annie has lived with Autoimmune Autonomic Ganglionopathy – AAG – since childhood, becoming sick at around age 12, though it took six years for anyone to name it. By the time doctors finally diagnosed the condition at 18, several of her organs were already failing.
According to the Cleveland Clinic, AAG is a rare condition affecting the autonomic nervous system – the system that controls involuntary body functions. In AAG, the immune system attacks the autonomic nervous system itself. The result is that the body can’t process the signals controlling everything from heartbeat to digestion, and the cascade of failures that follows can touch almost every system. There is no cure, and treatment typically involves immunosuppressants, plasma exchange, and intravenous therapies – managed case by case, because no standardized protocol exists.
AAG is extremely rare. In the United States, doctors diagnose about 100 people with it each year. The rarity itself compounds the suffering: there is no established roadmap, no community of patients who outnumber a small city. For some people, symptoms stabilize or even improve. For Annie, by the time the disease finally had a name, the damage was already significant. Her teeth have been deteriorating. She lives with constant pain and injects pain medication around the clock. She hasn’t eaten a real meal in ten years.
That last part is not a figure of speech. Annie’s digestive system can no longer function. Her nutrition comes through a line inserted directly into her bloodstream, a method called Total Parenteral Nutrition (TPN), bypassing the stomach entirely. And because that line goes straight into the bloodstream, any infection becomes sepsis with alarming speed. She has survived sepsis 25 times. She has fractured her spine in four places, split her sternum, and come close to crushing her heart and lungs – complications from long-term steroid treatment that caused severe osteoporosis. She has watched her twenties pass from hospital beds.
The Decision
Deciding to access voluntary assisted dying would have seemed unlikely, even for Annie, just a few years ago. “I used to be one of those people who was actually against voluntary assisted dying,” she has said. “It wasn’t until I got sick that my views on it completely changed.” It was meeting another young woman with AAG – Lily Thai, 23, who ended her own life using South Australia’s VAD laws shortly after they came into effect in 2023 – that made Annie realize this was an option she could access.
The fear didn’t disappear when she made the decision. Annie has described being “petrified.” Both things are true at once: petrified and relieved. Choosing how you die does not mean you are not afraid of dying. It means you have made a calculation about which fears are survivable and which ones are not. The fear of a death by sepsis or starvation – which is where her illness is headed – is one she has decided she cannot keep living alongside.
At 26, Annie is confronting the end of her life with a clarity that has moved people across multiple media outlets in Australia. She has been frank about her intention to access VAD, describing it as reclaiming dignity and agency after years of relentless suffering.
She underwent a three-week evaluation before receiving confirmation that she met all the legal criteria for voluntary assisted dying. She has said the decision brings her peace because it gives her control over the one part of her life she can still choose.
What the Law Actually Says
Australia’s approach to voluntary assisted dying has evolved significantly over the past several years. According to researchers writing in The Conversation, voluntary assisted dying is now lawful and being accessed across most of the country, with the Australian Capital Territory’s laws coming into effect in November 2025 – leaving only the Northern Territory without a scheme in place.
The laws are not casual about who qualifies. End of Life Law in Australia at QUT explains that to access VAD, a person must generally make at least three requests and be assessed as eligible by at least two independent medical practitioners, both of whom must have completed mandatory approved training. The process is deliberate and layered, designed to ensure that every person who accesses it has made a genuine, enduring, and uncoerced choice.
For many people – perhaps for most – this conversation is abstract. Something that happens to older people, people with late-stage cancer, people at the far end of a long life. Annie Holland is 26, and her story is a reminder that terminal illness does not keep to a schedule and does not limit itself to the old. The systems that were built with elderly patients in mind are now being accessed by young people who have spent their entire adult lives in a kind of suspended suffering, waiting for a body to give out that refuses to do so cleanly or quickly.
The fact that Annie has compiled what she calls a “Fuck It List” – things she’s always wanted to do, now that she knows the timeline – is one of those details that refuses to stay at a comfortable distance. It is not morbid. It is exactly what you do when you love your life and your body has made it impossible to keep living the way you wanted to live it. You make the list. You do the things. You don’t waste whatever time you have feeling guilty about the decision.
Her Family Is Living This Too
Annie’s family has struggled deeply with her choice. Her father, Patrick, initially hoped she would continue treatment, but a recent health crisis changed his perspective. The families of people choosing VAD are not bystanders; they are inside the decision too, at whatever angle they’ve been handed. A father who wanted his daughter to keep fighting, and then witnessed something that made him understand why she couldn’t – that is its own kind of grief, and it doesn’t resolve. It doesn’t get better in the way that ordinary grief eventually does, because the loss hasn’t happened yet and also, in some ways, has been happening for years.
There is a particular tenderness required of the people who love someone making this choice. They have to hold two things at once: their own need to keep the person they love alive, and their love for that person, which eventually has to mean accepting what she needs. Those two things do not peacefully coexist. They grind against each other every single day.
What Annie’s story puts in sharp relief is how little most of us think about what it means to have control over your own body and your own death until the question is no longer hypothetical. When we are well, we assume that control. We never have to ask for it. The people who do have to ask – who have to fill out forms and attend assessments and wait three weeks for approval – are the people who understand what that control actually means. Processing what the end of a loved one’s life looks like is something most families are completely unprepared for, even when there is time to prepare.
What This Actually Asks of the Rest of Us
Annie Holland has been public about her story by choice. She doesn’t have to do this. She could spend her remaining months entirely privately, doing her list, being with the people she loves, and not fielding questions from strangers. The fact that she has chosen visibility is an act of generosity – a deliberate effort to make these conversations easier for people who come after her, who might not know that VAD is an option, who might not know there is a name for what they’re living with.
She said something, in one of the interviews she gave, that stays with you. She said she doesn’t want to wake up every day with anxiety about the pain that’s coming – the pain of what her illness will do to her body if she lets it run its course. Knowing she can choose her moment is, she said, a huge relief.
That is not a person who has given up. That is a person who has done the math on her own suffering and made a decision that most of us will never have to make. The courage in that is not diminished by the fear that lives right alongside it.
The Weight of It, and What We Do With That
There is no way to read about Annaliese Holland and come away entirely unchanged. Twenty-six years old. A decade without food. Twenty-five rounds of sepsis. Spinal fractures from the medication that was supposed to help. A “Fuck It List” because the ordinary list – the one with the career and the relationship and the things you’ll get around to eventually – isn’t available anymore.
If you’ve lost someone to a long illness, or if you’re watching someone you love decline right now, her story probably strikes somewhere close. Not because the mechanics are identical, but because the weight is familiar: the way illness takes up residence in a family, the way everyone finds a different angle on the same impossible situation, the way love sometimes has to look like letting go before anyone is ready to let go.
Annie has been clear that she is “petrified.” She has also been clear that she has made her peace. Both of those things are real. Neither cancels the other out. The fear doesn’t mean she’s wrong, and the peace doesn’t mean it doesn’t hurt. She gets to have both, and so do the people who love her, and so do the rest of us sitting with this story at a safe distance.
We don’t have to resolve how we feel about it. We just have to be willing to feel it.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.