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?
The answer is no. Even though society is a polite entity and many times when something bad is occurring someone will step in and try to stop it no one is duty or legally bound to do so. If one walks down the street and sees someone beating another person to death they are under no legal obligation to interfere in any way.

While this sounds unfeeling it has been tested through a case that occurred in New York many years ago. In that case a woman was stabbed to dearth while several passer Byers did nothing but go about their business even though they could plainly see the woman was being murdered. No one was held responsible for that death other than the man who committed the crime because the court ruled that individuals are not duty bound to save a life.

A in the case of Anna, even though her refusal of a transplant would mean certain death for her sister she is not bound to comply nor are doctors bound by ethics to force her to do so.

The final question of ethics has to do with what happens to Anna's body after she has her accident. Anna went to court and fought against the doctors, her parents and the legal system to refuse to provide a transplant. Then on the way home from court she gets into a car accident and is left brain dead at which time her parents decided to use her kidney to save Kate after all.

Ethically this should not have been done. Anna had gone through the trouble to become emancipated and had not had the final paperwork completed however, the courts, the doctors, and her parents were aware that she had won the right to refuse to provide a kidney to her sister. The fact that final papers had not been completed was a mere housekeeping issue and the use of her kidney because of that was an unethical decision.

CONCLUSION

With each step closer to stem cell research and cloning of people that the medical community takes, more medical ethic questions appear. In the case of My Sister's Keeper parents made the decision to conceive and bear a genetically perfect match for their older daughter when she was diagnosed with leukemia. As Anna grew up however, she was able to decide that she no longer wanted to provide medical treatments for her sister. The novel eventually reveals that it was because her sister, Kate, asked her to refuse to provide more treatments because she was tired of the medical processes she had to go through however, the entire story raises inter4string ethics questions along the way. When all is said and done the parents were not acting unethically to have Anna in the hopes that she would save her sister's life. They did walk along the line of ethics when they forced her to spend her life saving Kate through medical procedures. They crossed that line when Anna won her battle not to do it anymore, but was in an accident before the final documents could be signed and her parents decided to use her kidney on Kate.

Medical ethics is a hot topic in America and promises to become even more so as medical advances continue to be discovered.

References

Leukemia (Accessed 11-11-06)

http://www.emedicinehealth.com/leukemia/article_em.htm

Signs and Symptoms (accessed 11-12-06)

http://www.oncologychannel.com/leukemias/symptoms.shtml

Picoult, Jodi, (2000) My Sister's Keeper

Thompson, Richard E (2006) Look what's happened to medical ethics: broader horizons, updated ideas, fresh language.(Innovations of health care ethics) Physician Executive