Blindspots and boundaries: Exploring the role and ethical responsibilities of facilitators of stem cell tourism

Stem cell "tourism" is often portrayed as the domain of lone patients desperately seeking cures abroad, guided only by their independent internet searches. While there is little doubt that prospective travelers are strongly influenced by direct-to-consumer online advertising and direct liaison with overseas clinics or individual providers, those considering a journey are also being encouraged, counseled, and even referred to providers of unproven stem cell interventions by travel “facilitators" that are variably co-located with providers, part of international consortiums or general medical travel agencies, and even based in the patients' own countries.
We explore here the roles played by stem cell travel facilitators and the ethical issues raised by their involvement in travel for unproven stem cell interventions. Drawing on Australian and international examples, and previous empirical research in the field of stem cell and general medical travel facilitation, we discuss the way that facilitators strive to compensate for information and evidence gaps concerning stem cell interventions so as to reassure prospective patients seeking to evaluate intervention provider options. We suggest that facilitators do so by drawing on traditional paradigms of practice - those of standard medical treatment, clinical research and medical innovation - to present the sale of unproven interventions as safely embedded in professional frameworks and grounded by established science. However, we argue that commercialisation of unproven stem cell interventions is in fact a distinct paradigm lacking many of the safeguards associated with traditional practices and in many cases lacking ethical grounds for implementation.
We contend that stem cell travel facilitators fall within blindspots of regulation, ethical responsibility, and public understanding, and often practice outside customary professional boundaries. In conclusion, we identify a set of core ethical responsibilities of facilitators, focused on their self-identified primary function as supporting informed decision-making by patients, and outline recommendations for their fulfilment.