"Beyond the state: First-person ethics and the governance of targeted therapies in China"

Drawing on ethnographic fieldwork conducted in China between 2018 and 2020, this paper discusses how experimental targeted therapies are governed not only by formal regulations but also by the ethical judgments of non-state actors. Two vignettes illuminate this argument: first, the encounter between a prominent biotech investigator and the chief oncologist at a hospital reveals clinicians' gatekeeping practices in response to social and institutional mistrust. Second, the selection of Tina, an international patient who was treated in China, illustrates how hospital staff evaluate patients' biological and clinical suitability for experimental medicine. These cases demonstrate that governance of experimental targeted therapies is distributed, relational, and morally situated, responding to both the imperatives of science and the state, and the social realities of patient vulnerability and social mistrust. We argue that the concept of first-person ethics, the personal moral reasoning enacted to discern how to achieve what is considered as "the good", offers a valuable lens for understanding how people at hospitals and biotech companies navigate the tensions between innovation, care, and risk.