Jodi Picoult’s novel, My Sister’s Keeper, introduces many complex themes such as ethical dilemmas, medical autonomy and justice. The story introduces Anna Fitzgerald, a thirteen year old girl, as the protagonist. Anna wishes to sue her parents for medical emancipation as Anna’s parents expect her to give up one of her kidneys for her older sister, Kate, who suffers from Leukaemia. Picoult tackles her subject with skill and sensitivity, and not only raises the themes into public consciousness, but makes them accessible to a wide audience.
The book reveals, early on, that Anna was conceived because Kate needed blood from the umbilical cord, in order to save her life. However, after the cord blood was given to Kate, Anna’s parents continued to use Anna for the donating of bone marrow and stem cells whenever Kate needed it. As Anna explains in the novel:
"I'm an allogeneic donor--a perfect sibling match. When Kate needs leukocytes or stem cells or bone marrow to fool her body into thinking it's healthy, I'm the one who provides them. Nearly every time Kate's hospitalized, I wind up there too." (Picoult, 2004: p. 13).
After thirteen years of this, Anna wants to be released from her role of donor, and the only way she can do this is by hiring a lawyer to help her through the courts. She spends time researching suitable lawyers, and then approaches Alexander Campbell, who is well-known as successful in representing minors in court.
The story leads through the stages of the lawsuit, and readers have the chance to understand the events from viewpoints of all of the main characters, including Anna, each of her parents, Kate, Jessie, Campbell and Anna’s guardian ad litem, Julia. Each of these characters offers a very different perspective on the dilemma and, through them, readers are able to grasp the complexity of the situation. In particular, Anna’s parents, Sarah and Brian, experience the true dichotomy; they love all three of their children, but if Anna withdraws her body from their control, their eldest daughter is likely to die.
My Sister’s Keeper clearly demonstrates how modern scientific advances have resulted in disputes between parents and children. Sarah and Brian conceived Anna almost exclusively for the reason that Kate needed the umbilical cord blood in order to live. Although they love Anna, Sarah and Brian continue to use her as a donor, which frequently involves putting her through painful procedures. Additional to this, due to Kate’s illness, their parents do not allow Anna to lead her own life; for example, she is not allowed go away on summer camps, in case Kate gets sick and Anna is needed to donate. In the novel, Anna speaks to Campbell of her feelings towards her parents:
"They don't really pay attention to me, except when they need my blood or something. I wouldn't even be alive, if it wasn't for Kate being sick." (Picoult, 2004: p. 33).
There is an obvious ethical dilemma present. Anna is an individual and just as worthy of her own life as Kate; however, without Anna’s help, Kate will die. This is such a problem because it can be viewed in different ways by different perspectives.
From a utilitarian point of view, Anna’s body should be used in order to temporarily save Kate’s life. According to the Utilitarian website,
“The principle of utility states that an action is right if it produces as much or more of an increase in happiness of all affected by it than any alternative action, and wrong if it does not” (Utilitarian, 2011).
Therefore, although the procedures are unpleasant and limiting for Anna, the benefits for all concerned are, overall, positive. If Anna donates one of her kidneys then Kate will survive the latest life-threatening attack of her illness. Moreover, the whole family, including Anna, get to keep Kate in their lives for a little longer. The likelihood is that Anna will survive the operation and make a full recovery. If looked at from this perspective, there is enough of an increase in happiness to justify the action of donating Anna’s kidney. Utilitarianism focuses on consequentialism and, therefore, as the outcome of the action is a good one, i.e. Kate’s life being saved for her and her family, it is justified as being the right one.
Virtue based ethics lead to much the same conclusion in this situation. According to the BBC Ethics website, virtue based ethics state that: “A right act is the action a virtuous person would do in the same circumstances” (BBC, 2011).
If people are asked whether a virtuous person would donate a kidney to their sister in order to save her life, the majority will answer in the affirmative. Common sense dictates that donating the kidney is the virtuous, and therefore the right, course of action.
Of course, this discussion is made more difficult where, near the climax of the book, Picoult reveals to the readers that Anna’s whole position has been instructed by Kate. In other words, Kate has begged Anna to go through the courts in order to liberate both of them from the constant treatments. Ironically, Anna would give her kidney to Kate – the two sisters are very close – but as Kate wants her to go through the courts, Anna is prepared to do this, even if it means turning her whole family against her. Nonetheless, for the sake of the argument posed throughout most of the story, virtue based ethics indicate that Anna should give her sister whatever she needs, within reason, to save her life.
The principle of totality brings an interesting conundrum to the argument. As Scaria Kanniyakonil points out on the Life Issues website,
“From the medical perspective, the principle of totality would mean that all the parts of the human body, as parts, are meant to exist and function for the good of the whole body, and are thus naturally subordinated to the good of the whole body” (Kanniyakonil, 2011).
Therefore, according to this principle, Anna’s kidneys, bone marrow and stem cells are in her body as they are required; they should not be taken out as they exist for the good of her whole body. However, where more tricky circumstances are posed, the principle then leads to the principle of double effect, which states that any mutilation of the body must be for the benefit of the species (Kanniyakonil, 2011). Therefore, it could be argued that Anna’s kidney is helping another human and, therefore, is for the good of the species. On the other hand, Kate is just one person, and is no more important than Anna and, therefore, Anna’s kidney should remain in her own body.
Similar to the opposing views of the principals of totality and those of double effect, are the medically based principals of non-maleficence and those of beneficence. The principle of non-maleficence suggests that physicians should aim to do no harm to their patients (McCormick, 2011). This includes putting them at risks which are too high, or which do not justify the outcome for them. In this case, Anna should not be put in danger by having a serious operation such as a kidney removal; to do this would be to do Anna harm. Conversely, the principal of beneficence states that doctors should do all they can to benefit the patient (McCormick, 2011). If viewing Kate as the patient, her doctors should do everything they can for her which, in this case, means giving her a new kidney in order to save her life. Without the new kidney, Kate will almost certainly die and, therefore, it is in her best interests to have the operation. However, if viewing Anna as the patient, she should not be harmed.
In this situation, as in all situations, patient autonomy needs to be taken into account. Medicine Net defines patient autonomy as: “The right of patients to make decisions about their medical care without their health care provider trying to influence the decision.” (Medicine, 2011). Medical professionals are allowed to educate patients, answer any questions truthfully and objectively, and provide support. However, the decision should lay firmly with the patient. In this case, as Anna does not wish to have the operation, her autonomy should be respected.
Eventually, justice is achieved when Campbell and Anna win their case against Anna’s parents. Anna is awarded medical emancipation and, by this time, Picoult’s readers are aware that Kate has had her wishes granted as well.
My Sister’s Keeper addresses some fascinating topical issues about matters that have arisen as a result of advancing medical knowledge and technology. The novel is, at times, laden with cliché, and is arguably not Picoult’s most literary work. However, her easy to read style, along with her notoriously well researched facts, is what has made her such a popular and widely read author. Through her writing she has made a difficult and largely unconsidered topic more present in the minds of the general public.
References
BBC Ethics. (2011). Virtue Ethics. Retrieved from
http://www.bbc.co.uk/ethics/introduction/virtue.shtml
Kanniyakonil, S. (2011). Principle of Totality and its Relevance in Bioethics. Life Issues.
Retrieved from http://www.lifeissues.net/writers/kan/kan_07totality1.html
McCormick, T. R. (2011). Principals of Bioethics. University of Washington School of
Medicine. Retrieved from
http://depts.washington.edu/bioethx/tools/princpl.html#prin2
Medicine Net. (2011). Definition of Patient Autonomy. Retrieved from
http://www.medterms.com/script/main/art.asp?articlekey=13551
Pegasus. (2011). Rights-Based Morality. Retrieved from
http://pegasus.cc.ucf.edu/~stanlick/right-basedmorality.html
Picoult, J. (2005). My Sister’s Keeper. Hodder Paperbacks.
Utilitarian. (2011). Introduction to Utilitarianism. Retrieved from
http://www.utilitarian.org/utility.html
