My Sister’s Keeper (2004)
By Jodi Picoult
Conceived as an allogenic donor for her sister, Anna decides to take legal action to protect her body from further medical procedures.
When Kate Fitzgerald is a toddler, doctors diagnose her with a rare and highly fatal form of leukemia. Because of the difficulty of treatment, including frequent operations necessary to sustain Kate’s life, her oncologist estimates that she will die within a few years. Kate’s parents, Sara and Brian, decide to increase her chance for survival by conceiving another child, one that has been laboratory-tested at the embryonic stage for organ compatibility with Kate. Anna is born about one year later, and for the next thirteen years, she is in the hospital as often as her sister is, donating red and white cells and bone marrow with each of Kate’s relapses. When Kate goes into kidney failure, the Fitzgeralds are shocked when Anna consults a lawyer to seek an injunction against the kidney donation. Anna seems torn about opposing her parents, particularly her mother, who sees this as a betrayal and a certain death sentence for Kate, yet she proceeds to seek medical emancipation. This high-profile case hinges on Anna’s rights as a patient, and whether or not her parents can make medical decisions for her based on their desire to keep their other daughter alive. The family begins to splinter, with Brian taking Anna’s side and Sara trying to keep Kate alive through the trial.
Anna claims that unlike most people, she knows her purpose in life: to improve her sister’s health with her own. Her conception and her court case each spark debates over genetic engineering of embryos, and the ethics of conceiving a child as a genetic match and potential donor for another child. Her parents receive hate mail from those opposing “designer babies”, but both Sara and Brian claim to love Anna on her own merits and distinguish themselves from parents who vet embryos for eye color or height. They associate themselves with parents who test embryos for life-threatening illnesses like Tay-Sachs, those who take medical action to avoid health threats written into their children’s genes. They recognize moral validity in their conception of Anna, but Anna’s predetermined role as Kate’s donor raises another set of issues regarding the ethics of creating a donor. Given that her parents have always viewed her as Kate’s savior, could they keep her best interests in mind while making medical decisions, if “best interests” means avoiding invasive and traumatic procedures at the expense of Kate’s health? This novel deals with the emotional ramifications of Anna’s knowledge of the circumstances surrounding her conception; by defying her parents, she feels guilt because the burden of Kate’s health has become inextricably entwined with her identity. This affects her older brother as well, who feels that because he does not have a place in the family because he does not express the requisite genes for compatibility. Kate also finds it difficult to assert herself as independent of her sister, as each of their identities are linked to the possibilities inherent in their genetic correspondence.
Evaluation: Picoult focuses on the potential emotional trauma born of conceiving children with future organ donations in mind. As this is a contemporary issue that has sparked much debate in recent years, this novel could produce fruitful discussions about human “insurance policies” and reproductive ethics.
– Natalie Champ