Pulling the Plug

     At the very end of My Sister's Keeper, Anna is declared braindead after finding herself in a tragic car accident. In the book, both Campbell Alexander and her parents do not hesitate to harvest Anna's organs and pull the plug. The main reason this decision was so easy for them was because Kate's life depended on Anna's kidney. Although they were unsure as to whether or not the kidney would help Kate, they were willing to take the risk anyway. Thankfully Kate made a full recovery after receiving the transplant and would most likely get to live a long and happy life.
     On the other hand, what happens when a person's loved one is in a similar situation, but they are not quite ready to let go? The issue at hand is life support. When someone is on life support, they are not breathing for themselves or doing anything for themselves; they are fully supported by machines that breathe and live for them. Many people that are against pulling the plug on life support hold on in hopes that their loved one will make a miraculous recovery. The patient's family holds onto the sliver of hope that they have praying that God will grant them a miracle. Unfortunately, many times there is no phenomenal recovery and at some point the life support needs to end. Although it does not happen often, sometimes a miraculous recovery is made, so how do family members know when they can pull the plug or not? Unlike the previous three ethical issues within this blog, there is not a clear answer.

     Pulling the plug mainly has to do with the idea of ensoulment - the idea that a person has a soul. I would imagine that if people could confirm that their loved one's body no longer had a soul, they would easily be able to let go. However, there is no "soul test" to determine if that person will come back to a normal life or not. Not to mention, people outside of the Christian tradition may not believe in a soul at all. How do we address the controversy of life support in an ethical manner?
     As I have done with the previous three issues, I will consult the Bible for an answer. First, we must establish that under the Christian tradition - I realize this is not the case for everyone - that there is a soul. This is shown countless times throughout the Bible, but the most famous verse mentioning the soul is "Love the Lord your God with all your heart and with all your soul and with all your strength," in Deuteronomy 6:5. Therefore, if one believes that the body has a soul, the absence of that soul would then lead one to conclude that the person is no longer alive rather is supported only by  a machine. The idea that the body and soul are separated is shown in Matthew 10:28 where he states, "Do not be afraid of those who kill the body but cannot kill the soul. Rather, be afraid of the One who can destroy both soul and body in hell." Since someone can kill the body but not the soul, it suggests that they are two separate entities. This passage also shows that the soul is the portion of people that live on in either heaven or hell. Therefore, if there was a way to determine if the soul had left the body, life support would be a far easier decision.
     However, as it is, life support is not easy to deal with. Unfortunately, there is nothing within the Bible that provides an easy answer either. Therefore, I think the only approach that we can take is to prayerfully consider the decision when encountering this situation.

Medical Emancipation

     One of the biggest issues within My Sister's Keeper is the idea of medical emancipation. Anna sues her parents for the rights to her own body. This was mainly brought on by the idea that medical procedures were forced upon her in order to save her sister Kate. Could this be a problem within the society we live in?
     While it is not often heard of in today's society, it is something that is a possibility. Therefore, I believe that it is important to hold the ethical discussion of medical emancipation before it becomes a major issue in society.
     First of all, it is necessary to clarify that medical emancipation is not the same thing as actual emancipation. Medical emancipation is not a child looking to live away from their parents or being out from their jurisdiction completely. Instead, medical emancipation is strictly removing medical jurisdiction from the parents and giving it to the child.
     In most cases, medical emancipation would not be at all necessary. After all how many children are actually forced to go through medical procedures without their consent? However, this could be a possible scenario for a very sick child who is tired of having their quality of life decrease because of the constant experimentation with procedures trying to cure the incurable. In this instance, if the parents are unwilling to allow the child to enjoy the amount of time - whether large or small - they have left, medical emancipation may be a possibility. Now that we see how medical emancipation could be applied in a scenario different from that of Anna and Kate, it is necessary to consult the moral aspects of medical emancipation.
     As I have done in my previous blogs, I am going to consult the Bible to see the morality of medical emancipation. One obvious problem with medical emancipation in the Bible is it goes against the commandment to obey your parents. This is stated clearly in Ephesians 6:1-3, which states, "Children, obey your parents in the Lord, for this is right. 'Honor your father and mother'—which is the first commandment with a promise— 'so that it may go well with you and that you may enjoy long life on the earth.'" This verse is pretty clear that we are supposed to obey our parents. However, it assumes that what the parents are asking follows the word of God. What happens if they do not? If one were to look in Ezekiel 20:18-19 it states, "I said to their children in the wilderness, 'Do not follow the statutes of your parents or keep their laws or defile yourselves with their idols. I am the Lord your God; follow my decrees and be careful to keep my laws.'" By looking at this verse it shows that no matter what a person is supposed to do as God commands even if your parents say otherwise. Thus, where does this leave someone who wants medical emancipation?
     To this I respond that God gives free will. We have the free will to choose to love God or not, to do the right thing or not. Therefore, if parents are wrongly making a child go through with medical procedures without their consent or best benefit in mind, medical emancipation is a moral option. However, if the parents are acting with the child's best interests in mind and according to the will of God, the child must remain under control of their parents.
'

Organ Donation

     When Anna's organs are donated to people in need after she is declared braindead, she is saving the lives of other people - including her sister Kate. Organ donation is tricky in the sense that it does not always work. In Kate's case, it was likely that Anna's kidney would be a successful transplant because she was already the ideal donor in the sense that she was a perfect genetic match. However, most people are not so lucky as to have a perfect genetic match in this world.

      In my own life, I know a man in his late twenties who is in desperate need of a kidney transplant. Unlike Kate, he does not have a family member that is a match, so he is dependent on a stranger's willingness to give up one of their kidneys. The demand for kidneys is far higher than the supply, so most people are on dialysis while waiting for possibly the rest of their lives waiting for a transplant. Then if and when he does receive a transplant, there is no guarantee that it will work; the patient's body may reject the unknown organ and believe that it is a threat. On the other hand, there are cases where the transplant is successful and a life is saved as a result. Kidney transplants is just one example of donation in which there can be a living donor.

     Unfortunately, many times organ donation relies on people who have recently died. Many have experienced this type when they get their driver's license. Either people can opt to be an organ donor or not. Someone may ask, where does the controversy lie? The answer to that is when there are cases where someone who is a viable organ donor never designated their feelings on organ donation to their family. The family is then forced to make a decision on behalf of the patient. While I personally believe that organ donation is always a good thing, not everyone agrees. Some people believe that organ donation is a mutilation of the body and should not be done. Thus, lies the controversy.
     As I did in my previous post, I will address this controversy by looking to the Bible and seeing what is to be said. In the same way designer babies are never mentioned in the Bible, organ donation is not either. However, there are countless verses in the Bible that deal with donation and gifts. One such example is 2 Corinthians 9:7-8, which states, "Each of you should give what you have decided in your heart to give, not reluctantly or under compulsion, for God loves a cheerful giver. And God is able to bless you abundantly, so that in all things at all times, having all that you need, you will abound in every good work." While the Bible does not condone forcing people to give a gift, if people do so in a cheerful and without reluctance, that gift would surely be blessed.
    Where does this leave people that have not expressed their feelings toward organ donation? At that point, the donor is no longer alive, and therefore, the responsibility is entrusted to the closest family member. If that person then chooses to donate the patients organs in a cheerful way, then it is an acceptable thing to do. However, if other people try to guilt the family into donating the organs, it should not be done. Even though this does not give a definite decision one way or another, I believe that applying this verse to this situation will shed light on each individual circumstance. 

Designer Babies

     The story within My Sister's Keeper deals directly with the controversial topic of designer babies. Anna was made to be spare parts for her sister - a whole different ethical issue that will be discussed at a later date - by choosing specific genes to make her a genetic match for Kate. Someone may ask, when is doing this ever a moral decision? This process was originally designed to combat disease. For example, if two want-to-be parents were both carriers for a fatal disease were afraid to have children because of that, this process allows them to choose the specific genes to prevent that child from having that disease. Thus, a couple that previously was unable to have children with a clear conscience now can. In this sense, I believe that most people would agree that messing with the genes is an honorable thing to do. However, people have now taken that concept and run with it.
      Instead of only controlling genes to prevent disease, people now are wanting to use that technology to choose the gender and characteristics of their child. For instance, if a woman wanted her child to be musically talented, athletic, and artistic, the technology is close to being able to do exactly that. This technology is creating designer babies or sometimes called super babies. Just because we can do this, does that mean that we should?
     While there are many sources people turn toward to seek ethical and moral advice when these dilemmas arise, I will turn my attention to that of the Bible and what it has to say on this topic. Some may say that the Bible never says anything about "designer babies", and they would be correct. However, the Bible does say something about the origin of life. In Genesis 2, God created man by breathing into his nostrils after forming him from the dust of the earth. He then made woman from a rib taken from Adam, the man he just created, to be a helper and companion to man.
      When God created humans, He intended to be the sole Creator. It was never intended for humans to try and fill the role of God by creating life. By manipulating the genes to create something that may or may not have occurred naturally is meddling in the matters of God; it is the beginning of humans trying to become like God. Does this mean that even changing the genes to avoid disease is wrong according to the Bible? Yes. Despite the honorable intentions in that process, this still involves people meddling with God's intentions in creation. The correct response to that problem, according to the Bible, would be to trust God that the child would be born without the fatal disease naturally.

The End

Anna’s reaction to being in court is not what one would expect from a 13-year-old who is filing a lawsuit against her parents. Instead of enjoying watching her mother being cross-examined, Anna feels pity and simply wants the trial to be over – not exactly what one would expect to hear out of a teenager filing for medical emancipation. Two doctors, Dr. Bergen and Dr. Chance, both testify next. Like many doctors that are called into court, they are eager to leave and get back to their patients. After both of the testimonies from the doctors, it can be concluded that they believe that everyone is doing their best to do what is in the best interests for the entire Fitzgerald family.

            The novel then flashed back to 2002 when Kate is in remission for a short time before relapsing. We learn of the story of Taylor Ambrose. As one can expect, Kate met this boy in the hospital while he was getting chemo and she was receiving platelets. They flirted and eventually Taylor asks for Kate’s number, which she happily gives him. One quote that describes the relationship between Taylor and Kate perfectly is when Sara says, “The arsenic, which ultimately put Kate into remission, worked its magic by wearing her down. Taylor Ambrose, a drug of an entirely different sort, works his magic by building her up” (310). Even when Kate begins to relapse, he is there for her to rub her back as she vomits during chemo. Taylor is one thing in Kate’s life that actually makes her genuinely happy. Even in this environment, Taylor asks Kate to the hospital’s “prom” – a memory she believed that she would never get the chance to have. The dance was just a couple days away and finding a dress was Kate’s nightmare (she was doing her best to cover up the many scars she had). Kate said that for just one night she wanted to feel beautiful. Sara ended up finding a beautiful dress for her on eBay, and the family took plenty of pictures to remember that special night. After Kate’s perfect night with Taylor, three days had passed and she had not even heard from him. Sara was also troubled by this, so she asked one of the nurses if he had been here this morning only to find out he had died. Since Kate had just started chemotherapy and would be hospitalized for about a month, Sara decided to wait to tell her – she did not want her to give up fighting for herself. Once Sara did tell Kate, Kate was furious and incredibly melancholy. Kate loved Taylor.

            Brian gets called to another fire; this time it is at the elementary school. It is clear once Brian looks at the fire’s damage that it was also started by the arsonist that he has been trying to track down for months. Until Brian finds a cigarette butt on the ground at the fire’s site, he still has no idea that Jesse is the one that has been starting all these fires. Once Brian discovers that it was Jesse, he goes home and confronts him about it showing that he knows of Jesse’s arson. After Jesse breaks down and admits that he has been starting the fires, Brian realizes that the reason Jesse started in the first place was because it was his way of dealing with the pain in the family. Fire was Jesse’s way of controlling something when the rest of his life seemed to go on, with or without him. Although Brian understood why Jesse did this, he still was certain that he would make sure Jesse never did it again.

            When they all go back to court the next day, Campbell is depending on Brian’s testimony in Anna’s favor. With Brian as a witness, winning this case would be significantly easier. However, once Brian gets on the stand and it comes time for him to say he believes that Anna is right, he doesn’t. Instead he states that he believes Anna should still donate her kidney. While this is definitely a setback to Campbell’s and Anna’s case, it now would be almost impossible to win without Anna’s testimony. At present, Anna refuses to testify in court, and argues that that is the reason she hired Campbell in the first place. After Sara cross-examines Brian, she realizes that they are once again on the same page – trying to do what is best for their family. It is after all this that Brian and Anna finally return home.

            Later in court Julia Romano, the guardian ad litem, testifies. She says that she believes that after considering both sides and trying to determine what the best course of action is for Anna, she has come to the conclusion that neither Anna nor her parents are capable of making a decision for Anna’s behalf that is unbiased. This is mainly because no matter who in the family makes the decision, they will be making the decision that also effects other members of the family in drastic ways. Julia’s recommendation to the court is one that the reader most likely does not suspect; she does not know what to recommend to the court. It is at this point that Anna asks to take the stand.

            While Campbell begins to ask Anna questions, Judge – the dog – begins to go crazy. Judge DeSalvo asks Alexander to quiet his dog, but to continue questioning the witness. One question led to Anna saying that someone convinced her to file this lawsuit, which caught everyone by surprise.  Who? Kate convinced Anna to file the case. At this point Judge is going absolutely crazy until Campbell collapses and begins to have a seizure.

            Brian rushes to Campbell’s side and gets him stable while determining that he just had a grand mal. It is at this point in the novel that we finally find out why Campbell Alexander has a service dog; he is an epileptic. After having a seizure, he had lost control of his body including his bowels. Luckily, Brian had brought a spare pair of pants for him to wear to finish the trial. Julia, who was completely unaware of Campbell’s condition, is now more concerned than angry about the past. The reader finds out that Campbell has had this condition since he was 18 and has not told anyone about it. Campbell also explains to Julia that the reason he left her was because he did not want to burden her independent spirit with him, especially since he could have a seizure at any moment. We finally understand what truly occurred between Julia and Campbell. After telling Julia all of this, she says that this time Campbell doesn’t get to leave her because she is going to leave him. After telling her to go, Julia says, “’I will…In another fifty or sixty years’” (385). The reader finally gets the reconciliation of these two that we have been waiting for.

            Once the trial resumes and Anna is once again in the hot seat, Campbell asks Anna what Kate asked her to do. Her response was this: “’She asked me to kill her’” (388). This was definitely not what anyone in the courtroom expected to hear. Everyone was surprised.  Kate was tired of living like this for a long time, but she could not bring herself to kill herself, so she asked Anna to do it for her. After hearing this information, Judge DeSalvo decides he needs to talk to Kate now, especially after all of this newfound information.

            Judge DeSalvo gives his verdict the next morning that he is granting Anna medical emancipation from her parents and that Campbell Alexander is to be her medical power of attorney. Even though this trial started out as a terrible break between the family, the entire family is happy with this outcome. Campbell and Anna stay a little later to fill out some of the paperwork, while the rest of Anna’s family goes ahead to the hospital to meet them afterward.

            While Brian is at the hospital, he gets a call from work that there has been an accident and the crew needs his help. He gets to the crash scene and sees a giant truck that had t-boned a small BMW. The BMW looked like an accordion wrapped around the front end of the truck.  Brian learns that the driver went through the windshield and has already been taken to the hospital, but there are still two people in the back of the BMW that they cannot get out. As Brian is working his way from the trunk of the car trying to get the people out, one of his crew opens up the door with the Jaws of Life and a dog runs out of the car. It is at this moment that the person whose blood is smeared all over the back window is none other than Anna’s. They get Campbell out of the car and then finally Anna; her pulse is weak. Once the ambulance arrives, they rush her to the hospital. At one point they had to use the paddles to jump-start her heart again – getting her small pulse back. After they get to the hospital, Campbell and Sara find Brian, who is without words, and the doctor informs them that Anna is brain-
dead.

            Even though this is a tragic moment for most, Kate gets Anna’s kidney after all; this allows her to provide an epilogue for the reader. Kate hated herself because she believed that this was all her fault. If she had not asked Anna to stop donating to her, she never would have filed the lawsuit – never would have been in that intersection. Eventually she got to the point where she realized, Anna would have wanted us to be happy. They kept in touch with Campbell and Julia for a while – until it got too painful. The Fitzgeralds even went to their wedding. Jesse graduated from the police academy, which suggests he turned his life around for the better. Brian started drinking and has been struggling to stop since then. Kate graduated high school and is teaching ballet – something that makes her think of Anna. Besides all of the pictures and memories of Anna that Kate has, she has her kidney; something of Anna’s that will always be with her.

            This is not a happy ending by any means, but it is a real one.

Playing Favorites

     In the beginning of the third portion of this novel, the reader gets a little more detail about what happened between Campbell and Julia. We get the idea that Campbell's parents would not approve of Julia because she is not one of the typical girls of rich families at Wheeler High School. Julia believes that since Campbell's parents do not approve of her that he just used her to make them upset, but Campbell tries to assure her that's not the case - to no avail. Even though Campbell may have been able to do more to try and convince Julia that he truly loves her, he decides to turn away and not turn back.
     Campbell eventually comes to find Anna and her father, Brian, at the fire station. It is in this moment that Brian admits that he believes that Anna is right about everything and is even willing to testify on her behalf in court. This is a huge turning point in the case. Up until this point, it is believed that no one ever really stuck up for Anna. However, this preconception is shown to be incorrect when we learn about when Anna donates bone marrow to Kate.

      For those who do not understand the bone marrow procedure, it is not exactly a pleasant one. The donor has to be put under anesthesia in order to not be under unbearable pain. An extremely long needle is then inserted into the bone from the hip to withdraw the bone marrow needed for a transplant. Before Anna has this procedure done, we hear Sara say, "'You don't have to do this if you don't want to, but I know that Kate is counting on you. And Daddy and me'" (231). While this does appear that this is the only known attempt from Sara to actually ask Anna's permission, it still does not display the procedure in its true light. However, Anna does - in this case - give her consent to the procedure. After the transplant occurs, Anna asks for Sara to come into her room - as she is currently with Kate. Sara finds Anna balling and wants her mother to stay with her, but is denied and told that her mother needs to stay with Kate. The response Anna gives displays what is more common to Anna's life, "'But I'm in the hospital,' she says. 'I'm in the hospital!'" (233). Even though Anna is in the hospital too, Kate is still shown as the number one priority in the Fitzgerald family.
     One inspiring aspect of Sara Fitzgerald that we see is when Kate is doing well enough to go out and do things, but chooses not to go anywhere. Kate is so self-conscious about herself since it is obvious that she has cancer just by looking at her. In response to this teen's self pity, Sara shaves her head - completely shaves her head. This is one moment where Sara does display her love for her daughter. Even if her love is not always equal between her daughters, Sara clearly cares about them.
    It is at this point in the book that we discover Kate's true health at this moment. Dr. Chance, Kate's oncologist, tells them that unless she gets a kidney transplant, she will die within a week or so. Finding out this information gives the family a whole new tension about the trial. Shortly after getting this information, Brian tells Sara that he plans to testify on Anna's behalf. It is now clear that Sara knows that with one parent testifying on Anna's behalf, the court will rule in Anna's favor. After receiving this news, Sara does what a good lawyer has to do at this point, ask for a settlement. Sara offers this scenario to Anna: if Anna donates this kidney to Kate, she will never be forced to donate anything else. However, Anna quickly declines.
   This brings the reader to the time of the hearing. Campbell and Sara show up looking for Anna to find that she is not there. Both of them realize immediately where Anna is, and Campbell finds her at the hospital with Kate. Before Campbell takes Anna to the courthouse, he does his best to get to the bottom of what she really wants because the signs are very inconsistent. In the end, he does not get anywhere with Anna, but he does know that Anna wants to continue with the case.
   It ends with Sara being questioned vigorously about Anna's health in the past. While it may seem like Campbell is getting his way, Sara has a response that makes everyone - including the reader - think twice about what position Sara has been put in, "'Aren't you asking me to that very thing?' Sara asks, 'Only this time, to favor the other child?'" (298). This quote makes the reader wonder, is it possible to think of this situation without favoring either Kate or Anna?

It's Complicated

            While in the next portion of Picoult’s novel the question asked in the previous post is not answered, new background information about Anna’s relationship with each of her parents is given. This part of the novel begins with Sara, Anna’s mother, who remembers a time when she was still pregnant with Anna. Sara is getting her hair done with two other strangers who both happen to be pregnant. They are all talking about their expected children when the questions come to Sara. One of the women asks Sara if she has a name picked out yet. It is in this moment that Sara realizes that she has not even thought of the specifics of this unborn child. In fact, she has only thought of her unborn daughter in terms of what she will be able to do for Kate. Sara no sooner has Anna than Anna is already unknowingly donating the umbilical cord to begin her many donations to Kate. Thus begins the lifelong cycle of Anna’s – donate to her sister only for it to help for a brief period of time.

            Back in present time of the novel, we are introduced to Julia Romano, the ad litem assigned to Anna’s case. The ad litem is used to determine what is best for Anna. She talks to Anna to determine whether or not her mother is influencing Anna’s thinking in regard to the lawsuit. Since it is Anna’s mother we are talking about, it is expected that Sara has tried to get Anna to drop the suit. Julia speaks with Anna and tries to find what solution is best in regard to a living situation that could obviously change Anna’s feelings on what she truly wants. After speaking with Anna at a zoo – she took her to a zoo to try and make her more comfortable – she comes to the conclusion that “Either this girl loses her sister, I think, or she’s going to lose herself” (p.113).  Once Julia has finished speaking with Anna, it is time for her to speak to the lawyer on the case, Campbell Alexander.

            The relationship between Julia and Campbell spans way beyond the legal relationship that it is first thought of. We learn that Julia and Campbell went to high school together and were seeing one another for some time before Campbell broke Julia’s heart. This encounter with Campbell is the first time in fifteen years that they have seen one another. It is explained in a later chapter that Julia was an outcast in high school; she was very different from the others. Despite not being popular with most people at the school, Campbell was very interested in her. They met at a graveyard together every day after school. It all seems to be going well until Julia and Campbell become intimate with one another. It is from this moment that it is implied that something went wrong in their relationship at this point; it also suggests that there is more to the story between them. At this time, Julia also blames Campbell for all of her bad relationships since then, which have not been better than those experiences.

            Once the relationship of Campbell and Julia is understood, it makes their interactions over this case make more sense. Campbell does his best to try and “win her back, “ but has up to this point failed. Mr. Alexander even goes to the point where he stops by Anna Fitzgerald’s house to try and get to know her better – as Julia suggested he did not even care about Anna – only to end up talking about legal issues with her. It is at this point that Campbell hears Sara talking to Anna about the case at home trying to get her to forget all about it, which causes him to file for a restraining order for Sara.

            In the midst of all of this, it is clear that Anna still cares deeply about her sister Kate. Throughout the entire process, she is concerned with Kate’s health and her relationship with her sister. Anna sneaks in the hospital room – doing her best to avoid a confrontation with her mother – to see Kate as much as she can. As the novel progresses, we learn more and more that Anna was never really given the choice to not donate things to her sister. Sara and Brian’s reasoning behind this is that “Why wouldn’t she want to save her sister’s life?” Despite everything that has happened between Anna and Kate, it is clear that they still care deeply for each other. It causes me, as a reader, to wonder why Anna is choosing to do this now, when she knows the consequences?

            When the restraining order is received, it does not go over well. Sara is once again furious at Anna, whom she soon realizes is not the one to blame. Sara, Campbell, Julia, Brian, and Anna go to the court to discuss the issue of the restraining order. While the Judge DeSalvo is speaking with Sara, Campbell, and Julia, Brian decides that Anna needs “breathing room” and takes her to the fire station to live with him there for a while. In the mean time at the courthouse, the judge declines the restraining order, but tells Sara that if she interferes with the case at home again, she will be reported to the bar of ethics. They all leave to find that Anna and her father are no longer there.

            Brian realizes that this could break apart their family right now, but believes that this will save it in the long run. It seems that there is finally someone that is concerned with Anna’s, not just Kate’s, well being.

One Life for Another

The story of Anna Fitzgerald and her family deals with one of the main ethical issues today: genetic engineering. Technology is advancing to the point where we can pick and choose the genes that we want a child to have. These scientific advances were originally designed to allow parents who were carriers of fatal diseases to have a child that would not be born with the disease, which many would say is a noble cause. However, with this ability comes the thought of "Can I choose the gender of my child?" or even beyond that "Can I make my child beautiful, smart, and musically talented?" These are the questions that are now causing genetic engineering to become an ethical issue within society.



Jodi Picoult is an author who often puts her characters through terrible events, such as surviving school shootings, being in Auschwitz, having cancer, and dealing with infidelity. When asked about this in an interview, Picoult stated that she does this partially because she is superstitious about it. She believes that if she writes about these horrible events happening to her characters, they will not happen to her family or in her area. While she knows this is not the case, it is something that justifies writing about terrible events. The novel that is focused on in this blog deals with a character that is diagnosed with cancer and the ramifications associated with a family member having cancer. http://www.jodipicoult.com/JodiPicoult.html

In the first one hundred pages of Picoult's novel, My Sister's Keeper, the youngest daughter of Brian and Sara Fitzgerald, Anna, is actually made to be spare parts for her older sister, Kate, who has been diagnosed with leukemia. Anna struggles with the origins of why people have children, which is mainly because she is concerned that she only exists because her sister is sick; if it weren't for Kate being diagnosed, she never would have been born at all. The Fitzgeralds already had two children before Anna - a son, Jesse, and a daughter, Kate. Unfortunately, their son Jesse was not a match to donate anything to Kate, thus the unborn Anna became the best option for Kate's survival. Anna has gone through many medical processes that have hospitalized her almost every time that her sister has been hospitalized to give Kate everything from blood to bone marrow. We now learn that Kate's kidneys are failing, and she needs a transplant, which Anna's parents assume she will give without a fight.

Instead we find Anna seeking out an attorney, Campbell Alexander,  to sue her parents for the rights to her own body, known as medical emancipation. When Anna's parents initially find out about what Anna is doing, they believe that she is joking and simply looking for attention. Much to their surprise, Anna is serious and determined to follow through with the legal processes involved. Anna's mother, Sara, is furious. She is not mad because of what she is doing, rather she is mainly upset about what this means for Kate and the rest of her family. Since Kate's leukemia is a very rare type of leukemia, she needs an exact genetic match for everything that goes into her body, which is why Anna was created in the first place. If Anna does not give Kate one of her kidneys, it is assumed that Kate will die.

Shortly after going to court to work out when the hearing will be, Kate becomes very sick and is found in her room throwing up blood - a sign of severe renal failure. Sara becomes concerned with whether it is still possible for Kate to receive a transplant, and discovers it is even more critical now for the kidney to come from Anna.  While Jesse is in the room when all of this is happening, Kate tells him to tell Anna. Now the question remains in Jesse's mind and the reader's mind - tell Anna what?