Recently it has been argued that there are genuine moral dilemmas and that any theory which does not account for this fact is an unrealistic one. This represents a challenge to an assumption that most moral theorists have held: an adequate ethical theory must not allow for genuine moral quandaries. John Stuart Mill, for example, in the last paragraph of the second chapter of Utilitarianism, seems to be committed to such an assumption. Many others have also assented to this view. The consensus among those who hold this view seems to be that if a theory allows for moral dilemmas then there is some sense in which it is incoherent or inconsistent. Yet, oddly enough, the sense in which such a view would be incoherent is rarely, if ever, spelled out. Put another way, there seem to be no arguments for the belief that genuine moral dilemmas must be ruled out.

's "Moral Dilemmas, Deliberation, and Choice,"* is a paper that moves in many directions and attempts to cover much ground. But, sorting through these intricacies, one can see that Anderson sets for himself two major tasks: one is to reject some of the principal claims made by Ruth Barcan Marcus in her recent work on moral dilemmas; † the other, to present his own (Aristotelian) account of moral reasoning which supposedly rectifies some of the problems found in Marcus's essay. Although there is much in Anderson's interpretation of Marcus and in his own positive position with which one might argue, I shall here confine myself to several misunderstandings of Marcus which I believe reveal more basic confusions about the issues raised by moral dilemmas and their implication for ethical theory.

Over the past decade, genetic tests have become available for a wide variety of disorders. As a result we are able to predict, with some degree of certainty, whether or not an individual will develop such diseases as breast cancer, Huntington's disease, polycystic kidney disease, and familial adenomatous polyposis. The ability to predict disease poses several unique ethical considerations for clinical decisionmaking regarding the provision of genetic testing. Patients must be able to comprehend the complexities of genetic testing and the potential meaning of the results. Patients must consider the emotional, social, and economic consequences of revelations regarding their risk status. Also, obtaining information on risk status may have implications for persons other than the individual seeking genetic testing. The decision to test children for risk of genetic disease is further complicated by the fact that, until they reach the age of majority or are deemed emancipated minors, parents must make decisions on their behalf. Children have particular developmental, social, and emotional vulnerabilities that must be considered in any decision to conduct genetic testing and/or impart results to them. Policies regarding genetic testing in children seem to vary according to whether any medical benefit is to be expected from testing. For example, population-based screening for phenylketonuria, hemoglobinopathies, and galactosemia are a routine part of pediatric care. Testing for these conditions has been shown to reduce morbidity and mortality, and there are now few ethical concerns regarding current population-based screening programs. Also, testing children for genetic conditions such as cystic fibrosis and sickle cell anemia is relatively uncontroversial as there are significant benefits to be derived from early diagnosis and medical treatment. However, genetic testing becomes more controversial when there are no or questionable medical benefits to be derived, such as in late-onset autosomal dominant diseases. Consider the case presented by Smith et al. 1 Mr. Crawford's son married a woman at risk for Huntington's Disease (HD). The couple, now divorced, was married for eight years and had a son and daughter. The boy is now eight years old and the girl is six. These children are at 25 percent risk for HD. Mr. Crawford believes that the mother of his former daughter-in-law has been diagnosed with HD; the former daughter-in-law has repeatedly said that she is not interested in testing for herself. Mr. Crawford has other children and grandchildren; a widower of significant means, he has been diagnosed with inoperable cancer. He wishes to treat his grand

Using cardiopulmonary resuscitation for cardiac or respiratory arrest unless there is an explicit do-not-resuscitate order is a policy adopted by all hospitals. Such a policy usually requires the patient's (or surrogate's) consent for a do-not-resuscitate order to be instituted. This article, however, presents the argument that consent need not always be obtained. In the case discussed, the well-being of the patient, other patients, and the health care providers all support a unilateral decision by the physician not to attempt resuscitation at the time of death. The medical community and society need to acknowledge that such cases exist and to develop policies that respect not only the interests of patients but also those of health care providers and society.

Recently a well-known magazine published an article entitled ‘Moral Specialist.’ This article recounts the activities of Russell McIntyre, described by the authors as a theologian and philosopher who specializes in bioethics. McIntyre is routinely consulted by physicians for help in solving ethical problems. He is asked for moral advice on such matters as abortion, euthanasia, and sterilization for teenagers. McIntyre even wears an electronic ‘beeper’ so that when untimely moral quandaries arise he can easily be reached. McIntyre says that ultimately such moral decisions should be made by the people involved — the physician, the patient, and the family. However, he claims that there are still many gray areas in bioethics ‘where it is best to call in an expert for consultation.’