In their discussion of the ethics of research with those who have dementia, Berghmans and ter Meulen draw a primary distinction between two categories of biomedical research: 'therapeutic' and 'non-therapeutic'. They deal mainly with the latter, believing (correctly, in my view also) that it is here that the main ethical difficulties arise. A basic justification for 'non-therapeutic' research is proffered. It is suggested also that five conditions would need to be met to permit research in any particular instance; one of these is the guarantee that the research will genuinely advance the cause of science, while the other four function mainly to safeguard the persons involved.
The article provides some very helpful clarifications, much needed in a field that has a somewhat murky history and in which contemporary controversies abound. I believe that the authors are correct in their assertion that the issues are hardly ever clear cut; usually it will not be possible to settle matters by simple appeal to one principle, and some kind of 'weighing' will be necessary. I also agree with their wish to clarify and tighten the ethical conditions for research on those who have dementia. However, I have serious doubts about their way of justifying 'non-therapeutic' research. I also believe that much is still left unresolved after their discussion, largely because they have stayed with generalities and not attempted to apply their ideas to any specific field.
The ethical justification given for 'non-therapeutic' research is, essentially, a lex talionis curandi: 'Is it morally wrong to expect demented patients, in exchange for their care by society, to help medical researchers in their efforts towards increased insight in and understanding of this condition?'. An equitable exchange or balance is clearly presupposed.