Sister\'s Keeper by Jodi Picoult

¶ … Sister's Keeper by Jodi Picoult to critically analyze ethical issues in the medical profession. The writer explores several of the book's more sensitive topics and details the ethical dilemma that they surround. There were five sources used to complete this paper.

For the past few decades, the medical community has made advances that society never before dreamed possible. People are living longer than ever before, and their quality of life has reached an all time high even up into the golden years. There is currently much controversy surrounding the idea and practice of stem cell research and the cloning of cells. The ethics of this practice have been hotly debated since its inception with members of society lining up either for or against the issue. With the advances in medical science ethical questions are coming into play as well.

One well-known work of fiction delves into the ethical dilemmas that the medical community in real life is just beginning to face. In My Sister's Keeper, by Jodi Picoult one sister is conceived through genetic selection to act as a spare part human model for her older sister who has cancer.

For this young girl's entire life she has provided bone marrow, platelets and other necessary interventions whenever her sister would become ill again. At the opening of the book however, Anna (the younger sister who is being used for her parts) hires an attorney and fights to win the right to refuse to give up any more of her body or time in the quest to save her sister.

This time Kate, (the sister with cancer) needs a kidney and their parents want to force Anna to give up a kidney. Anna is 13 years old and retains an attorney for the purpose of refusing to do so. The book is well written and addresses many of the personal and ethical issues that a family would face given the same situation. In the end Anna wins, the family finds out it's not about Anna being selfish, but about her fulfilling Kate's wish to stop fighting the illness and die.

Anna gets in a car accident on the way back from winning her court case and she is brain dead, so her parents end up using her kidney to save Kate anyway and it does turn out to be the final phase of the illness for Kate who goes on to live a full and productive life.

There are many ethical questions and issues that are raised throughout the book, which closely resemble some of the things that are currently being experienced in today's medical community.

DEMOGRAPHICS

The demographics of the family involved are average when compared to many of today's American families. There is a mother who at one time was a licensed and practicing attorney, however, when her children were born she made the decision to stay home and raise them. When the issue of Anna refusing to provide a kidney to Kate comes up, she decides to dust off her license and represent herself in the suit to emancipate Anna's medical decision making ability.

The father is a fireman. It is interesting because Jake, the oldest child and the only boy is not only experimenting with drugs he is also running around setting fires that his dad has to put out.

The parents do not figure out until the last part of the story that it is their son who is doing the fire setting in some sort of cry for attention. All of his life it seems that Kate has received the most attention because she is the one who has the life threatening illness, while Anna also receives her fair share of attention because she provides the medical treatments that her older sister needs.

The older brother is all but completely ignored and many believe that is delinquent adventures are nothing more than a young boy crying out to be noticed in a family where he has grown up as the invisible entity.

Kate is the middle child and the one with the illness. She is a bit spunky and sassy and sarcastic as many teenagers her age are, yet she has a wiseness about her beyond her years, probably due to all she has endured medically.

Anna is the same. She is far beyond her years in many areas of thinking and it is probably due to the fact that she was born for the sole purpose of saving her sister and her entire life has been spent remaining healthy so that whenever Kate needed something Anna could provide it to her. She grew up providing blood, platelets and anything else Kate needed until the subject of a kidney transplant arrived and it was the first time she refused. She is mature in many areas but there are still areas in which she is a child. One example of this is the fact that she saved all she could to pay the attorney without having a clue that her meager offerings would be nothing compared to his hourly rate. Luckily for Anna he agrees to take the case for free, or at least the meager amount she has promised him.

ETHICS IN HEALTHCARE

Today, perhaps more than ever before, professionals in the medical community face ethics questions and decisions. The stem cell research issues and all that surround them have brought forth the truth in what society and individuals are willing or not willing to do for the sake of life.

Ethical issues that surround today's medical decisions are unlike any that have been faced in the past. Today, machinery and medications are able to maintain life support almost indefinitely. In addition there is a lot going on in the world of research that will soon allow body parts to be grown. There are worldwide debates as to the ethics of such treatment, but when one takes the novel My Sister's Keeper, holds it against today's abilities and practices it is not hard to see that such questions are facing those who work in the medical field today (Thompson, 2006).

In some cases, traditional medical ethics issues and bioethics issues overlap. For example, the need for testing gene therapy products in humans prior to approval adds a new dimension to safeguarding the safety of human research subjects (Thompson, 2006)."

For one to understand the ethical issues in My Sister's Keeper one must have an understanding of the disorder and the usual treatments for that disorder that is illustrated in the book.

KATE

Kate, the subject of the needed medical treatments suffers from leukemia. It is a rare form of leukemia and one that many young adults die from in short order. While the disease is indeed life threatening, great advances and stride have been made recently so that the cure rate for childhood leukemia has gotten much higher than it has been in the past.

Leukemia can be a tricky disorder as its beginning symptoms can be vague and non-alarming. The child might start out with flu like symptoms that can include a sore throat, a fever and an upset stomach. In addition the child may begin to display bruises for which no explanation can be found. All of the symptoms together add up to something to call the doctor about, but one at a time or having just a few of them often go unnoticed or garner a "wait and see" attitude by parents and professionals alike.

In addition to the more obvious symptoms of leukemia other symptoms include:

Signs and Symptoms (http://www.oncologychannel.com/leukemias/symptoms.shtml)

Fatigue

Malaise (vague feeling of bodily discomfort)

Abnormal bleeding

Excessive bruising

Weakness

Reduced exercise tolerance

Weight loss

Bone or joint pain

Infection and fever

Abdominal pain or "fullness"

Enlarged spleen, lymph nodes, and liver (Thompson, 2006). "

Other manifestations of the disorder include enlarged spleen and enlarged liver as those organs are directly impacted by the leukemia.

Leukemia is a blood cancer that creates overgrowth in the bone marrow. The process of cancer destroys and crowds out the other cells and eventually begins to destroy organs throughout the body as well.

Normal blood contains 3 major groups of cells: white blood cells, red blood cells, and platelets. All 3 types of blood cells develop from one immature cell type, called blood/marrow stem cells, in a process called hematopoiesis (Leukemia (http://www.emedicinehealth.com/leukemia/article_em.htm)."

The stem cells continue to divide and develop and goes through many stages in the bone marrow.

Leukemia is more common in white people than in people of color. Anna and Kate's family is white.

For decades ago the survival rate for all Leukemia's was 14%, but with the current medical advances the overall cure rate is now 50%. However, that includes all leukemia's, individual types have varying survival rates.

Risk factors for the disorder include smoking, exposure to certain chemicals, certain medical syndromes and genetic predisposition to the development of the disease.

Diagnosis of the disorder includes blood count work, physical examination and if those point to possible leukemia then a biopsy is ordered. A biopsy of the bone marrow is the only way to be sure that it is leukemia.

TREATMENT

Treatments for leukemia can vary depending on the stage, the age of the patient, the type of leukemia, and the advanced or infant stages that it is in, but most leukemia patients do go through a host of treatments that include chemotherapy.

Treatment also depends on the stage that the disease is placed in. Staging is simply a method by which the cancer is categorized for the purpose of developing a treatment plan and for research purposes with regards to cure rates and treatment successes or failures (Leukemia (http://www.emedicinehealth.com/leukemia/article_em.htm).

In most cases of the disease, including Kate's case the treatment of choice is chemotherapy. There is a scene in the novel in which Anna, Kate and their mother are dancing around the kitchen together after shaving their heads so Kate would not feel awkward about losing her hair during a chemotherapy course of treatment.

ETHICS

There are several ethics questions that can be related to this story. The first and foremost question of ethics was whether or not Anna's parents had the right to conceive and give her life for the sole purpose of providing parts and medical needs for her older sister. While the parents did grow to love their second daughter, many people believe that the purposeful conception and birth for this purpose is unethical at best and horrific at worst.

The idea of creating a human parts machine is extremely distasteful and unfair to the child who comes into the world as a part house.

When the question of ethics comes into the picture those who support what families like this one did point out the fact that the child is loved, regardless of the circumstances of its birth and conception.

Throughout the nation parents have had to face ethical decisions with regard to the medical care of one or more of their children.

In one recent case of conjoined twins the parents, who were devoutly Catholic refused all medical treatment to separate and save the twins. They believed it was God's will that they had been born like that and it was God who should decide whether the conjoined girls would live or die (Tierney, 2002).

During that hearing the court ruling stated in part that the parents had a right to make themselves into martyrs for their personal convictions but that they had no legal, ethical or moral right to make their children into martyrs for their personal beliefs.

In the same way that the court rules in that case it could be said that Anna had the right to fight against her parents based on the fact that they had her for the sole purpose of becoming a martyr in the quest to save Kate.

The next ethical question is founded in the fact that she had been forced her entire life to provide medical treatments for her sister whenever the need arose.

In the case of the twins the courts faced an interesting dilemma regarding the rights of the children. Children have the right to medical treatment but parents also have the right to choose or refuse said treatment within reason.

In the case of Anna and Kate the parents were trying to choose a medical treatment for Kate while forcing a medical treatment upon Anna. The ethics of such a decision created a hotly debated court case in the novel from which the court believed that Anna should not have to subject herself to more medical procedures even if her refusal to do so would mean certain death for her older sister.

The next ethics question is whether or not Anna should be duty bound and court ordered to provide the kidney for her sister.

There are several issues at the crux of this particular question. Anna has the exact match and her kidney could very well save Kate's life, however, she refuses to provide it, which according to the doctors will mean certain death for Kate. Is this murder by Anna? If Anna refuses to comply will she be in fact killing her sister?