My Sister's Keeper, by Jodi Picoult

I will discuss the central ethical dilemma of Jodi Picoult’s My Sister’s Keeper, the way the story has been told using multiple character perspectives, the issue of medical ethics, and the ending of the novel.

Many readers have had a strong response to the ending and a lot of fans of the novel have expressed their concern that the film had a different ending. Jodi Picoult even put a message on her website expressing her own concerns and explaining the situation surrounding the change (that is, that she [or possibly her publisher] had sold the film rights and, although she was disappointed, the decision to change the ending was not hers – but that there are still a lot of good points to the film).

I, personally, listened to the audio-book of the novel then watched the film (then got the novel to see it on the page). However, some may prefer to watch the film then read or listen to the novel so you don’t focus on what is missing from the film instead of what is included. If you intend to read or listen to the novel at some stage, I recommend doing it before you read on – or at least before you read past the spoiler alert further down. The audio-book has the added bonus of being read by Jodi Picoult herself. I think it is very beneficial to hear writing read by the author because I can listen to the way they deliver the words and the emphases they place on different aspects of the writing in the way they read it.

You can purchase the audio-book and be listening to it within minutes (when you choose the download option) via the following link:

My Sister's Keeper
Picoult also has a range of free audio interviews, podcasts, and extra material about the novels on her website
The Amazon page for Jodi Picoultalso has U.S. book tour dates and a movie trailer for My Sister’s Keeper.

The major ethical dilemma: is it right to sacrifice one child for another?

The major ethical dilemma and source of conflict for the plot is as follows: Kate needs a kidney or she will die. Her sister Anna is the only compatible donor available. Anna gets a lawyer and seeks medical emancipation from her parents so she won’t have to donate her kidney. Their mother, a lawyer, commits to fighting Anna’s efforts at medical emancipation so Kate can get Anna’s kidney.

Early in the novel, the reader is faced with the issue of how much it is reasonable to expect Anna to sacrifice for Kate. Should she give up her kidney, or should she be able to choose not to donate it – even if that means Kate will die?

Picoult has described My Sister’s Keeper as “Sophie’s Choice for the twenty-first century.” I will discuss the aspect of a choice to sacrifice one child for another in My Sister’s Keeper, and the overt as well as implicit ways this is conveyed, in more detail further on.
One of the things that I think Picoult does well as a writer is to develop stories based on a strong ethical dilemma and facilitating an understanding of multiple sides to the dilemma. While doing this, she also keeps the plot and the nature of the main conflicts between the characters clear throughout each novel. In her novels, Picoult has consistently created fictional situations in which she focuses on multiple characters, each holding a key opinion about the situation which conflicts with that of another character. Rather than attempt to convey a message with each novel, Picoult raises a question that can be transferred to life beyond the novel and encourages each reader to understand several opinions on how to approach the question.

(Comparison: Paul Haggis has used a similar approach with his films, raising questions such as ‘Would you ever cheat on your partner?’ and ‘How would you respond to being cheated on by your partner?’ in The Last Kiss; and ‘What lengths would you go to to achieve your goals in life?’ and ‘Is a short life lived genuinely according to your convictions more valuable than a long life of just getting by and deferring or giving up on your goals?’ in Million Dollar Baby.)

Networked multi-perspective narrative

Picoult has said, in an interview with Bill Thompson, that “I couldn’t let one of them tell you the story because they all had a right to explain to you why they had made the choices they’d made, and that why I wound up with this particular set of multiple narratives."

In a podcast on her website, Picoult has said “I thought I was writing a story about a family stricken by one daughter’s terminal illness and that Anna was gonna tell you that story, but I began considering the point of view of everyone else in the family too.” She has told of the inspiration she drew from her own experience of having a child with an illness [an ear condition requiring a number of operations] and how this gave her an insight into how such an illness could impact on members of a family. She continued “I thought of all the sacrifices my other children had made when Jake [her son] was sick; birthday parties they’d missed and Open School Night presentations we didn’t attend. I thought of the fight I once had with my son Kyle, who wanted to know why getting strep throat didn’t rate as high as Jake’s condition. […] When one child gets sick, the whole family does. A family unit is a finite shape and pulling hard on one part of it means that another part has to give a little.”

In the novel, Picoult has used six distinct character perspectives to tell the story. This contributes to the understanding of multiple opinions on how to approach the major question of the novel rather than conveying a single message. Readers are encouraged to consider various ethical dilemmas surrounding the issue of sacrificing one child for another via the characters of Anna Fitzgerald, her mother Sara, her father Brian, her brother Jesse, her lawyer Campbell Alexander, and a court-appointed counselor Julia Romano who spends some time with Anna to find out what her wishes are and form an opinion on whether it is appropriate for Anna to remain in her parent’s home in the lead up to the trial.

Medical Ethics at the Trial

At the trial, a member of the Ethics Board from the hospital Kate and Anna have frequented throughout their lives was questioned about the ethics of the hospital and he gave the following account, which came under six principles:
Autonomy; or the idea that any patient over age 18 has the right to refuse treatment
Veracity; which is basically informed consent
Fidelity; that is a healthcare provider fulfilling his duties
Beneficence; or doing what’s best in the interests of the patient
Non-maleficence; when you can no longer do good, you shouldn’t do harm like performing major surgery on a terminally ill patient who is 102 years old; and finally
Justice; that no patient should be discriminated against in receiving treatment.

This account of medical ethics both provides some guidance for judging ethical decisions and hints at a range of areas in which differences of opinion may occur. Anna’s case highlights how ethical guidelines such as those above can be considered in various ways and their application is not always black and white, but can contain many shades of grey. What Picoult does is place such ethical concerns into a ‘novel about family, relationships, and love’; a phrase she associates with all her novels.



This is your last chance to read or listen to the novel before reading on.


Losing Anna

Near the end, having won medical emancipation, Anna is in a car crash, attended by her father in his capacity as a firefighter. In an emotional scene, he pulls her out of the wreckage. She dies, and Kate gets her kidney.

One daughter has been inadvertently sacrificed for another; not by a deliberate choice but by an accident that arose indirectly from the circumstances initiated by wanting Anna to donate her kidney. Anna was bred to give from her body to sustain the life of her sister, but her parents had not intended on sacrificing Anna’s life for Kate’s; they just wanted to use her as a compatible biological donor of blood… then other things like bone marrow… then a kidney. The theme of sacrificing one life to sustain another is made very concrete with the death of Anna and the donation of her kidney. However, throughout the whole story, there is a range of more subtle ways in which Anna and other members of the family are sacrificed for Kate:

Anna has been subjected to many medical procedures throughout her childhood.

Sara has given up her job as a lawyer.

Little attention has been paid to Jesse and he has been getting into trouble.

Brian has become the sole provider for a family, with three children and probably very expensive medical costs, that has gone from two incomes to one.

In a way, the whole family have sacrificed their own enjoyment and meaningful engagement in their own lives to focus their combined efforts on a losing battle to save Kate.

In the end, Anna’s kidney saves Kate… barely.

The whole ending with Anna’d death and Kate’s recovery is different in the film version, in which it turns out Kate had asked Anna to refuse to donate her kidney because the kidney would only prolong her life of sickness, not cure her, and she was ready to die. In the film, Kate dies and Anna is granted medical emancipation, putting the focus of the story more on their mother’s journey to accept the inevitable death of Kate.

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