Introduction

Jodi Picoult tells the story of a girl who decides to sue her parents for the rights to her own body in this New York Times bestseller that tackles a controversial subject with grace and explores what it means to be a good person.

New York Times bestselling author Jodi Picoult is widely acclaimed for her keen insights into the hearts and minds of real people. Now she tells the emotionally riveting story of a family torn apart by conflicting needs and a passionate love that triumphs over human weakness.

Anna is not sick, but she might as well be. By age thirteen, she has undergone countless surgeries, transfusions, and shots so that her older sister, Kate, can somehow fight the leukemia that has plagued her since childhood. The product of preimplantation genetic diagnosis, Anna was conceived as a bone marrow match for Kate—a life and a role that she has never challenged...until now. Like most teenagers, Anna is beginning to question who she truly is. But unlike most teenagers, she has always been defined in terms of her sister—and so Anna makes a decision that for most would be unthinkable, a decision that will tear her family apart and have perhaps fatal consequences for the sister she loves.

My Sister’s Keeper examines what it means to be a good parent, a good sister, a good person. Is it morally correct to do whatever it takes to save a child’s life, even if that means infringing upon the rights of another? Is it worth trying to discover who you really are, if that quest makes you like yourself less? Should you follow your own heart, or let others lead you? Once again, in My Sister’s Keeper, Jodi Picoult tackles a controversial real-life subject with grace, wisdom, and sensitivity.

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Excerpt

Chapter One: Anna

When I was little, the great mystery to me wasn't how babies were made, but why. The mechanics I understood -- my older brother Jesse had filled me in -- although at the time I was sure he'd heard half of it wrong. Other kids my age were busy looking up the words penis and vagina in the classroom dictionary when the teacher had her back turned, but I paid attention to different details. Like why some mothers only had one child, while other families seemed to multiply before your eyes. Or how the new girl in school, Sedona, told anyone who'd listen that she was named for the place where her parents were vacationing when they made her ("Good thing they weren't staying in Jersey City," my father used to say).

Now that I am thirteen, these distinctions are only more complicated: the eighth-grader who dropped out of school because she got into trouble; a neighbor who got herself pregnant in the hopes it would keep her husband from filing for divorce. I'm telling you, if aliens landed on earth today and took a good hard look at why babies get born, they'd conclude that most people have children by accident, or because they drink too much on a certain night, or because birth control isn't one hundred percent, or for a thousand other reasons that really aren't very flattering.

On the other hand, I was born for a very specific purpose. I wasn't the result of a cheap bottle of wine or a full moon or the heat of the moment. I was born because a scientist managed to hook up my mother's eggs and my father's sperm to create a specific combination of precious genetic material. In fact, when Jesse told me how babies get made and I, the great disbeliever, decided to ask my parents the truth, I got more than I bargained for. They sat me down and told me all the usual stuff, of course -- but they also explained that they chose little embryonic me, specifically, because I could save my sister, Kate. "We loved you even more," my mother made sure to say, "because we knew what exactly we were getting."

It made me wonder, though, what would have happened if Kate had been healthy. Chances are, I'd still be floating up in Heaven or wherever, waiting to be attached to a body to spend some time on Earth. Certainly I would not be part of this family. See, unlike the rest of the free world, I didn't get here by accident. And if your parents have you for a reason, then that reason better exist. Because once it's gone, so are you.

Pawnshops may be full of junk, but they're also a breeding ground for stories, if you ask me, not that you did. What happened to make a person trade in the Never Before Worn Diamond Solitaire? Who needed money so badly they'd sell a teddy bear missing an eye? As I walk up to the counter, I wonder if someone will look at the locket I'm about to give up, and ask these same questions.

The man at the cash register has a nose the shape of a turnip, and eyes sunk so deep I can't imagine how he sees well enough to go about his business. "Need something?" he asks.

It's all I can do to not turn around and walk out the door, pretend I've come in by mistake. The only thing that keeps me steady is knowing I am not the first person to stand in front of this counter holding the one item in the world I never thought I'd part with.

"I have something to sell," I tell him.

"Am I supposed to guess what it is?"

"Oh." Swallowing, I pull the locket out of the pocket of my jeans. The heart falls on the glass counter in a pool of its own chain. "It's

fourteen-karat gold," I pitch. "Hardly ever worn." This is a lie; until this morning, I haven't taken it off in seven years. My father gave it to me when I was six after the bone marrow harvest, because he said anyone who was giving her sister such a major present deserved one of her own. Seeing it there, on the counter, my neck feels shivery and naked.

The owner puts a loop up to his eye, which makes it seem almost normal size. "I'll give you twenty."

"Dollars?"

"No, pesos. What did you think?"

"It's worth five times that!" I'm guessing.

The owner shrugs. "I'm not the one who needs the money."

I pick up the locket, resigned to sealing the deal, and the strangest thing happens -- my hand, it just clamps shut like the Jaws of Life. My face goes red with the effort to peel apart my fingers. It takes what seems like an hour for that locket to spill into the owner's outstretched palm. His eyes stay on my face, softer now. "Tell them you lost it," he offers, advice tossed in for free.

If Mr. Webster had decided to put the word freak in his dictionary, Anna Fitzgerald would be the best definition he could give. It's more than just the way I look: refugee-skinny with absolutely no chest to speak of, hair the color of dirt, connect-the-dot freckles on my cheeks that, let me tell you, do not fade with lemon juice or sunscreen or even, sadly, sandpaper. No, God was obviously in some kind of mood on my birthday, because he added to this fabulous physical combination the bigger picture -- the household into which I was born.

My parents tried to make things normal, but that's a relative term. The truth is, I was never really a kid. To be honest, neither were Kate and Jesse. I guess maybe my brother had his moment in the sun for the four years he was alive before Kate got diagnosed, but ever since then, we've been too busy looking over our shoulders to run headlong into growing up. You know how most little kids think they're like cartoon characters -- if an anvil drops on their heads they can peel themselves off the sidewalk and keep going? Well, I never once believed that. How could I, when we practically set a place for Death at the dinner table?

Kate has acute promyelocytic leukemia. Actually, that's not quite true -- right now she doesn't have it, but it's hibernating under her skin like a bear, until it decides to roar again. She was diagnosed when she was two; she's sixteen now. Molecular relapse and granulocyte and portacath -- these words are part of my vocabulary, even though I'll never find them on any SAT. 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.

None of which means anything, except that you shouldn't believe what you hear about me, least of all that which I tell you myself.

As I am coming up the stairs, my mother comes out of her room wearing another ball gown. "Ah," she says, turning her back to me. "Just the girl I wanted to see."

I zip it up and watch her twirl. My mother could be beautiful, if she were parachuted into someone else's life. She has long dark hair and the fine collarbones of a princess, but the corners of her mouth turn down, like she's swallowed bitter news. She doesn't have much free time, since a calendar is something that can change drastically if my sister develops a bruise or a nosebleed, but what she does have she spends at Bluefly.com, ordering ridiculously fancy evening dresses for places she is never going to go. "What do you think?" she asks.

The gown is all the colors of a sunset, and made out of material that swishes when she moves. It's strapless, what a star might wear sashaying down a red carpet -- totally not the dress code for a suburban house in Upper Darby, RI. My mother twists her hair into a knot and holds it in place. On her bed are three other dresses -- one slinky and black, one bugle-beaded, one that seems impossibly small. "You look..."

Tired. The word bubbles right under my lips.

My mother goes perfectly still, and I wonder if I've said it without meaning to. She holds up a hand, shushing me, her ear cocked to the open doorway. "Did you hear that?"

"Hear what?"

"Kate."

"I didn't hear anything."

But she doesn't take my word for it, because when it comes to Kate she doesn't take anybody's word for it. She marches upstairs and opens up our bedroom door to find my sister hysterical on her bed, and just like that the world collapses again. My father, a closet astronomer, has tried to explain black holes to me, how they are so heavy they absorb everything, even light, right into their center. Moments like this are the same kind of vacuum; no matter what you cling to, you wind up being sucked in.

"Kate!" My mother sinks down to the floor, that stupid skirt a cloud around her. "Kate, honey, what hurts?"

Kate hugs a pillow to her stomach, and tears keep streaming down her face. Her pale hair is stuck to her face in damp streaks; her breathing's too tight. I stand frozen in the doorway of my own room, waiting for instructions: Call Daddy. Call 911. Call Dr. Chance. My mother goes so far as to shake a better explanation out of Kate. "It's Preston," she sobs. "He's leaving Serena for good."

That's when we notice the TV. On the screen, a blond hottie gives a longing look to a woman crying almost as hard as my sister, and then he slams the door. "But what hurts?" my mother asks, certain there has to be more to it than this.

"Oh my God," Kate says, sniffling. "Do you have any idea how much Serena and Preston have been through? Do you?"

That fist inside me relaxes, now that I know it's all right. Normal, in our house, is like a blanket too short for a bed -- sometimes it covers you just fine, and other times it leaves you cold and shaking; and worst of all, you never know which of the two it's going to be. I sit down on the end of Kate's bed. Although I'm only thirteen, I'm taller than her and every now and then people mistakenly assume I'm the older sister. At different times this summer she has been crazy for Callahan, Wyatt, and Liam, the male leads on this soap. Now, I guess, it's all about Preston. "There was the kidnapping scare," I volunteer. I actually followed that story line; Kate made me tape the show during her dialysis sessions.

"And the time she almost married his twin by mistake," Kate adds.

"Don't forget when he died in the boat accident. For two months, anyway." My mother joins the conversation, and I remember that she used to watch this soap, too, sitting with Kate in the hospital.

For the first time, Kate seems to notice my mother's outfit. "What are you wearing?"

"Oh. Something I'm sending back." She stands up in front of me so that I can undo her zipper. This mail-order compulsion, for any other mother, would be a wake-up call for therapy; for my mom, it would probably be considered a healthy break. I wonder if it's putting on someone else's skin for a while that she likes so much, or if it's the option of being able to send back a circumstance that just doesn't suit you. She looks at Kate, hard. "You're sure nothing hurts?"

After my mother leaves, Kate sinks a little. That's the only way to describe it -- how fast color drains from her face, how she disappears against the pillows. As she gets sicker, she fades a little more, until I am afraid one day I will wake up and not be able to see her at all. "Move," Kate orders. "You're blocking the picture."

So I go to sit on my own bed. "It's only the coming attractions."

"Well, if I die tonight I want to know what I'm missing."

I fluff my pillows up under my head. Kate, as usual, has swapped so that she has all the funchy ones that don't feel like rocks under your neck. She's supposed to deserve this, because she's three years older than me or because she's sick or because the moon is in Aquarius -- there's always a reason. I squint at the television, wishing I could flip through the stations, knowing I don't have a prayer. "Preston looks like he's made out of plastic."

"Then why did I hear you whispering his name last night into your pillow?"

"Shut up," I say.

"You shut up." Then Kate smiles at me. "He probably is gay, though. Quite a waste, considering the Fitzgerald sisters are -- " Wincing, she breaks off mid-sentence, and I roll toward her.

"Kate?"

She rubs her lower back. "It's nothing."

It's her kidneys. "Want me to get Mom?"

"Not yet." She reaches between our beds, which are just far apart enough for us to touch each other if we both try. I hold out my hand, too. When we were little we'd make this bridge and try to see how many Barbies we could get to balance on it.

Lately, I have been having nightmares, where I'm cut into so many pieces that there isn't enough of me to be put back together.

My father says that a fire will burn itself out, unless you open a window and give it fuel. I suppose that's what I'm doing, when you get right down to it; but then again, my dad also says that when flames are licking at your heels you've got to break a wall or two if you want to escape. So when Kate falls asleep from her meds I take the leather binder I keep between my mattress and box spring and go into the bathroom for privacy. I know Kate's been snooping -- I rigged up a red thread between the zipper's teeth to let me know who was prying into my stuff without my permission, but even though the thread's been torn there's nothing missing inside. I turn on the water in the bathtub so it sounds like I'm in there for a reason, and sit down on the floor to count.

If you add in the twenty dollars from the pawnshop, I have $136.87. It's not going to be enough, but there's got to be a way around that. Jesse didn't have $2,900 when he bought his beat-up Jeep, and the bank gave him some kind of loan. Of course, my parents had to sign the papers, too, and I doubt they're going to be willing to do that for me, given the circumstances. I count the money a second time, just in case the bills have miraculously reproduced, but math is math and the total stays the same. And then I read the newspaper clippings.

Campbell Alexander. It's a stupid name, in my opinion. It sounds like a bar drink that costs too much, or a brokerage firm. But you can't deny the man's track record.

To reach my brother's room, you actually have to leave the house, which is exactly the way he likes it. When Jesse turned sixteen he moved into the attic over the garage -- a perfect arrangement, since he didn't want my parents to see what he was doing and my parents didn't really want to see. Blocking the stairs to his place are four snow tires, a small wall of cartons, and an oak desk tipped onto its side. Sometimes I think Jesse sets up these obstacles himself, just to make getting to him more of a challenge.

I crawl over the mess and up the stairs, which vibrate with the bass from Jesse's stereo. It takes nearly five whole minutes before he hears me knocking. "What?" he snaps, opening the door a crack.

"Can I come in?"

He thinks twice, then steps back to let me enter. The room is a sea of dirty clothes and magazines and leftover Chinese take-out cartons; it smells like the sweaty tongue of a hockey skate. The only neat spot is the shelf where Jesse keeps his special collection -- a Jaguar's silver mascot, a Mercedes symbol, a Mustang's horse -- hood ornaments that he told me he just found lying around, although I'm not dumb enough to believe him.

Don't get me wrong -- it isn't that my parents don't care about Jesse or whatever trouble he's gotten himself mixed up in. It's just that they don't really have time to care about it, because it's a problem somewhere lower on the totem pole.

Jesse ignores me, going back to whatever he was doing on the far side of the mess. My attention is caught by a Crock-Pot -- one that disappeared out of the kitchen a few months ago -- which now sits on top of Jesse's TV with a copper tube threaded out of its lid and down through a plastic milk jug filled with ice, emptying into a glass Mason jar. Jesse may be a borderline delinquent, but he's brilliant. Just as I'm about to touch the contraption, Jesse turns around. "Hey!" He fairly flies over the couch to knock my hand away. "You'll screw up the condensing coil."

"Is this what I think it is?"

A nasty grin itches over his face. "Depends on what you think it is." He jimmies out the Mason jar, so that liquid drips onto the carpet. "Have a taste."

For a still made out of spit and glue, it produces pretty potent moonshine whiskey. An inferno races so fast through my belly and legs I fall back onto the couch. "Disgusting," I gasp.

Jesse laughs and takes a swig, too, although for him it goes down easier. "So what do you want from me?"

"How do you know I want something?"

"Because no one comes up here on a social call," he says, sitting on the arm of the couch. "And if it was something about Kate, you would've already told me."

"It is about Kate. Sort of." I press the newspaper clippings into my brother's hand; they'll do a better job explaining than I ever could. He scans them, then looks me right in the eye. His are the palest shade of silver, so surprising that sometimes when he stares at you, you can completely forget what you were planning to say.

"Don't mess with the system, Anna," he says bitterly. "We've all got our scripts down pat. Kate plays the Martyr. I'm the Lost Cause. And you, you're the Peacekeeper."

He thinks he knows me, but that goes both ways -- and when it comes to friction, Jesse is an addict. I look right at him. "Says who?"

Jesse agrees to wait for me in the parking lot. It's one of the few times I can recall him doing anything I tell him to do. I walk around to the front of the building, which has two gargoyles guarding its entrance.

Campbell Alexander, Esquire's office is on the third floor. The walls are paneled with wood the color of a chestnut mare's coat, and when I step onto the thick Oriental rug on the floor, my sneakers sink an inch. The secretary is wearing black pumps so shiny I can see my own face in them. I glance down at my cutoffs and the Keds that I tattooed last week with Magic Markers when I was bored.

The secretary has perfect skin and perfect eyebrows and honeybee lips, and she's using them to scream bloody murder at whoever's on the other end of the phone. "You cannot expect me to tell a judge that. Just because you don't want to hear Kleman rant and rave doesn't mean that I have to...no, actually, that raise was for the exceptional job I do and the crap I put up with on a daily basis, and as a matter of fact, while we're on -- " She holds the phone away from her ear; I can make out the buzz of disconnection. "Bastard," she mutters, and then seems to realize I'm standing three feet away. "Can I help you?"

She looks me over from head to toe, rating me on a general scale of first impressions, and finding me severely lacking. I lift my chin and pretend to be far more cool than I actually am. "I have an appointment with Mr. Alexander. At four o'clock."

"Your voice," she says. "On the phone, you didn't sound quite so..."

Young?

She smiles uncomfortably. "We don't try juvenile cases, as a rule.

If you'd like I can offer you the names of some practicing attorneys who -- "

I take a deep breath. "Actually," I interrupt, "you're wrong. Smith v. Whately, Edmunds v. Womens and Infants Hospital, and Jerome v. the Diocese of Providence all involved litigants under the age of eighteen. All three resulted in verdicts for Mr. Alexander's clients. And those were just in the past year."

The secretary blinks at me. Then a slow smile toasts her face, as if she's decided she just might like me after all. "Come to think of it, why don't you just wait in his office?" she suggests, and she stands up to show me the way.

Even if I spend every minute of the rest of my life reading, I do not believe that I will ever manage to consume the sheer number of words routed high and low on the walls of Campbell Alexander, Esquire's office. I do the math -- if there are 400 words or so on every page, and each of those legal books are 400 pages, and there are twenty on a shelf and six shelves per bookcase -- why, you're pushing nineteen million words, and that's only partway across the room.

I'm alone in the office long enough to note that his desk is so neat, you could play Chinese football on the blotter; that there is not a single photo of a wife or a kid or even himself; and that in spite of the fact that the room is spotless, there's a mug full of water sitting on the floor.

I find myself making up explanations: it's a swimming pool for an army of ants. It's some kind of primitive humidifier. It's a mirage.

I've nearly convinced myself about that last one, and am leaning over to touch it to see if it's real, when the door bursts open. I practically fall out of my chair and that puts me eye to eye with an incoming German shepherd, which spears me with a look and then marches over to the mug and starts to drink.

Campbell Alexander comes in, too. He's got black hair and he's at least as tall as my dad -- six feet -- with a right-angle jaw and eyes that look frozen over. He shrugs out of a suit jacket and hangs it neatly on the back of the door, then yanks a file out of a cabinet before moving to his desk. He never makes eye contact with me, but he starts talking all the same. "I don't want any Girl Scout cookies," Campbell Alexander says. "Although you do get Brownie points for tenacity. Ha." He smiles at his own joke.

"I'm not selling anything."

He glances at me curiously, then pushes a button on his phone. "Kerri," he says when the secretary answers. "What is this doing in my office?"

"I'm here to retain you," I say.

The lawyer releases the intercom button. "I don't think so."

"You don't even know if I have a case."

I take a step forward; so does the dog. For the first time I realize it's wearing one of those vests with a red cross on it, like a St. Bernard that might carry rum up a snowy mountain. I automatically reach out to pet him. "Don't," Alexander says. "Judge is a service dog."

My hand goes back to my side. "But you aren't blind."

"Thank you for pointing that out to me."

"So what's the matter with you?"

The minute I say it, I want to take it back. Haven't I watched Kate field this question from hundreds of rude people?

"I have an iron lung," Campbell Alexander says curtly, "and the dog keeps me from getting too close to magnets. Now, if you'd do me the exalted honor of leaving, my secretary can find you the name of someone who -- "

But I can't go yet. "Did you really sue God?" I take out all the newspaper clippings, smooth them on the bare desk.

A muscle tics in his cheek, and then he picks up the article lying on top. "I sued the Diocese of Providence, on behalf of a kid in one of their orphanages who needed an experimental treatment involving fetal tissue, which they felt violated Vatican II. However, it makes a much better headline to say that a nine-year-old is suing God for being stuck with the short end of the straw in life." I just stare at him. "Dylan Jerome," the lawyer admits, "wanted to sue God for not caring enough about him."

A rainbow might as well have cracked down the middle of that big mahogany desk. "Mr. Alexander," I say, "my sister has leukemia."

"I'm sorry to hear that. But even if I were willing to litigate against God again, which I'm not, you can't bring a lawsuit on someone else's behalf."

There is way too much to explain -- my own blood seeping into my sister's veins; the nurses holding me down to stick me for white cells Kate might borrow; the doctor saying they didn't get enough the first time around. The bruises and the deep bone ache after I gave up my marrow; the shots that sparked more stem cells in me, so that there'd be extra for my sister. The fact that I'm not sick, but I might as well be. The fact that the only reason I was born was as a harvest crop for Kate. The fact that even now, a major decision about me is being made, and no one's bothered to ask the one person who most deserves it to speak her opinion.

There's way too much to explain, and so I do the best I can. "It's not God. Just my parents," I say. "I want to sue them for the rights to my own body."

Copyright © 2004 by Jodi Picoult view abbreviated excerpt only...

Discussion Questions

Questions from Publisher's Reading Guide:

Questions and Topics for Discussion

1) One of this novel's strengths is the way it skillfully demonstrates the subjectivity people bring to their interactions with others. The motivations of individual characters, the emotions that pull them one way or another, and the personal feelings that they inject into professional situations becomes achingly clear as we explore many different viewpoints. For example, despite Julia and Campbell's attempts to remain calm, unemotional and businesslike when they deal with one another, the past keeps seeping in, clouding their interaction. The same goes for the interaction between Sara and Anna during the trial. Is there such a thing as an objective decision in the world of this story? Is anyone capable of being totally rational, or do emotions always come into play?

2) What do you think of this story's representation of the justice system? What was your opinion of the final outcome of the trial?

3) What is your opinion of Sara? With her life focused on saving Kate, she sometimes neglects her other children. Jesse is rapidly becoming a juvenile delinquent, and Anna is invisible -- a fact that the little girl knows only too well. What does this say about Sara's role as a mother? What would you have done in her shoes? Has she unwittingly forgotten Jesse and Anna, or do you think she has consciously chosen to neglect them -- either as an attempt to save a little energy for herself, or as some kind of punishment? Does Sara resent her other children for being healthy? Did you find yourself criticizing Sara, empathizing with her, or both?

4) During a conversation about Kate, Zanne tells Sara, "No one has to be a martyr 24/7." When she mistakenly hears the word "mother" not "martyr" and is corrected by Zanne, Sara smiles and asks, "Is there a difference?" In what ways does this moment provide insight into Sara's state of mind? Do you think it strange that she sees no difference between motherhood and martyrhood?

5) Campbell is certainly a fascinating character: guarded, intelligent, caring and yet selfish at the same time. Due to these seemingly contradictory traits, it can be difficult to figure him out. As he himself admits, "motivations are not what they seem to be." At one point he states, "Out of necessity -- medical and emotional -- I have gotten rather skilled at being an escape artist." Why do you think Campbell feels that he needs to hide his illness? Is it significant that Anna is the first to break down his barriers and hear the truth? Why, for example, does he flippantly dismiss all questions regarding Judge with sarcastic remarks?

6) At one point, Campbell thinks to himself: "There are two reasons not to tell the truth -- because lying will get you what you want, and because lying will keep someone from getting hurt." With this kind of thinking, Campbell gives himself an amazingly wide berth; he effectively frees himself from speaking any semblance of the truth as long as the lie will somehow benefit himself or anyone else. Did it concern you that a lawyer would express an opinion like this? Do you think, by the end of the story, that Campbell still thinks this moral flexibility is okay? In what ways might this kind of thinking actually wind up hurting Campbell?

7) It is interesting that Campbell suffers seizures that only his dog can foresee. How might this unique relationship mirror some of the relationships between humans in this novel? In what ways does Judge introduce important ideas about loyalty and instinct?

8) On page 149, Brian is talking to Julia about astronomy and says, "Dark matter has a gravitational effect on other objects. You can't see it, you can't feel it, but you can watch something being pulled in its direction." How is this symbolic of Kate's illness? What might be a possible reason for Brian's fascination with astronomy?

9) Near the end of the novel, Anna describes "Ifspeak" -- the language that all children know, but abandon as they grow older -- remarking that "Kids think with their brains cracked wide open; becoming an adult, I've decided, is only a slow sewing shut." Do you believe this to be true? What might children teach the adults in this novel? Which adults need lessons most?

10) "It's more like we're astronauts, each wearing a separate helmet, each sustained by our own source of air." This quote comes from Anna, as she and her parents sit in silence in the hospital cafeteria. Besides being a powerful image of the family members' isolation, this observation shows Anna to be one of the wisest, most perceptive characters in this novel. Discuss the alienation affecting these characters. While it is obvious that Anna's decision to sue her parents increases that sense of alienation throughout the novel (especially for Anna herself), do you think that she has permanently harmed the family dynamic?

11) During the trial, when Dr. Campbell takes the stand, he describes the rules by which the medical ethics committee, of which he is a part, rules their cases. Out of these six principles (autonomy, veracity, fidelity, beneficence, non-maleficence, and justice), which apply to Anna's lawsuit? Moreover, which of these should be applied to Anna's home situation? In other words, do you think a parent might have anything to learn from the guidelines that the doctors follow? Are there family ethics that ought to be put into place to ensure positive family dynamics? I so, what should they be?

12) Early in the legal proceedings, Anna makes a striking observation as she watches her mother slip back into her lawyer role, noting, "It is hard to believe that my mother used to do this for a living. She used to be someone else, once. I suppose we all were." Discuss the concept of change as it is presented in this story. While most of the characters seem to undergo a metamorphosis of sorts -- either emotionally or even physically (in the case of Kate), some seem more adept at it than others. Who do you think is ultimately the most capable of undergoing change and why?

13) Discuss the symbolic role that Jesse's pyromania plays in this novel, keeping in mind the following quote from Brian: "How does someone go from thinking that if he cannot rescue, he must destroy?" Why is it significant that Jesse has, in many respects, become the polar opposite of his father? But despite this, why is Jesse often finding himself in the reluctant hero position (saving Rat, delivering the baby at boot camp)? Brian himself comes to realize, in the scene where he confronts Jesse, that he and his son aren't so different. Talk about the traits that they share and the new understanding that they gain for each other by the end of the story.

14) My Sister's Keeper explores the moral, practical and emotional complications of putting one human being in pain or in danger for the well being of another. Discuss the different kinds of ethical problems that Anna, as the "designer baby," presents in this story? Did your view change as the story progressed? Why or why not? Has this novel changed any of your opinions about other conflicts in bioethics like stem cell research or genetically manipulated offspring?

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