Navigating the ‘grey areas’: Australian medical travellers in China’s stem cell bionetwork Jane Brophy School of Social Sciences, Monash University, 500 Wellington Road, Clayton, Vic. Australia, 3800. Email: jane.brophy@monash.edu Abstract: The last decade has seen a marked rise in the phenomenon of the so-called stem cell tourism, whereby people travel from their home countries to access unproven stem cell treatments abroad. Despite increasing attempts on an international level from regulators, policy-makers and scientists to deter people from undergoing potentially harmful treatments, patient demand persists. Over the last decade, China has emerged as a leading destination for people seeking such treatments, where providers of treatments operate in varying ‘shades of grey’. While Chinese government intervention has had some impact on the availability of treatments within China, top-down regulatory measures face limitations considering strong patient demand and the geographical flexibility demonstrated by both patients and providers. This article draws on interviews with Australian patients who have travelled to China for stem cell treatments, or considered it and decided against it, as well as representatives of stem cell clinics in China and other stakeholders. It argues that Australian patients and/or carers articulate a culturally situated moral imperative to act in the face of limited conventional biomedical options and that commercial clinics capitalise on this to attract new patients and sustain the demand – either ‘underground’ in China, or by moving to other jurisdictions. Keywords: Australia, China, medical travel, morality, patient decision-making, stem cells Introduction Stem cells, and their capacity to grow and regenerate new cells, have fuelled hope and hype around an imagined future of treatments and cures for a myriad of as-yet untreatable conditions (Brown et al., 2006; Petersen and Krisjansen, 2015). Because major advances in the use of haematopoietic stem cells in the 1960s led to their now-standard application in bone marrow transplantations, hopes have remained high, with new breakthroughs at the level of basic science in the 1990s and early 2000s renewing excitement about potential treatments and cures (Maienschein, 2011). Nonetheless, this large and promising field of research still has not resulted in major translational breakthroughs since the initial discovery of the use of stem cells to treat blood-based disorders. Over the last two decades, however, clinics around the world have embarked on the controversial practice of selling various ‘stem cell’ treatments in advance of evidence that meets international scientific standards. For patients wanting the opportunity to try these treatments, the last 15 years has seen the rise of so-called ‘stem cell tourism’. The phenomenon has sparked fierce debate in the scientific community regarding ethical practices in stem cell research and clinical translation (Lau et al., 2008; Sipp, 2009, 2013; Levine and Wolf, 2012), often demarcating between ‘legitimate’ and ‘illegitimate’ clinical practices (Sleeboom-Faulkner, 2010; Petersen et al., 2015). Treatments on offer target condi- tions for which no evidence-based treatments have been established by Western scientific stand- ards, such as spinal cord injury, autism and certain neurodegenerative diseases such as amyotrophic lateral sclerosis. Criticism of the treatments focus on patients’ safety, the potential for financial exploitation, as well as concerns that adverse outcomes could lead to a loss of public faith in promising stem cell treatments being developed under the standards of re- search and medical practice set by international peak institutions, such as the International Society for Stem Cell Research (Regenberg et al., 2009; Murdoch and Scott, 2010; Munsie and Hyun, Asia Pacific Viewpoint, Vol. 58, No. 2, August 2017 ISSN 1360-7456, pp216–227 © 2017 Victoria University of Wellington and John Wiley & Sons Australia, Ltd doi: 10.1111/apv.12162