Note: this critique is of the book My Sister’s Keeper, although I refer to the movie. The movie mostly follows the book until the final court scene, whereupon it goes off in two different directions. Discussion on both book and movie are welcome. Spoilers beware. (IMHO, it’s not worth reading, anyway.)
Jodi Picoult’s My Sister’s Keeper follows the life of the Fitzgerald family. Older sister Kate (played in the movie by Sofia Vassilieva from TV’s Medium) is chronically ill, suffering from leukemia-related illnesses since she was a young child. Her parents, Sara (Cameron Diaz) and Brian, concieved younger sister Anna (Abigail Breslin) as a genetically-engineered baby to be the perfect match for Kate as a blood and bone-marrow donor. For thirteen years. Anna has gone along with it, but when her parents ask for a kidney, she gets herself a lawyer and sues for medical emancipation; the right over her own body.
Now, I’m from Western Australia, where we have laws against both genetically-engineered babies and live transplants, so I was predisposed against the so-called ethics that Picoult raised in the books. To me, bringing a child into the world knowing they will have a chronically ill older sibling and that they were conceived for spare parts seems abhorrent, if understandable from a desperate parent’s perspective. And the risks that go along with being a live donor? The reason we don’t have it (though other Australian states do). I’m certainly interested in what people outside WA think.
Anyway, when Anna sues for emancipation, Sara hits the roof, calling Anna a selfish bitch and so on. Even when the court forbids Sara from speaking to Anna about to trial, she still tries and convinces Anna to save her sister’s life. Now, I’d hazard a guess that Picoult’s intention was to portray Sara as so desperate to use one daughter’s life to save the other that she convinces herself she’ll get two healthy daughters out of it – ignoring any risks to Anna’s health, in both short- and long-term, which may not even benefit Kate – but for me, she just came across as a woman who loves Kate first and foremost and sees Anna as a spare-parts factory. She sees nothing wrong with holding her toddler daughter down to get bone marrow drawn while her daughter kicks and screams; Anna’s constant skipping of school because of recovering from one procedure or another is treated as collateral damage to Kate’s well-being.
And the thing is, like many of Picoult’s novels, MSK often hits some sadly realistic notes. The Fitzgerald family haven’t been living for the last fifteen years so much as stuck on survival mode, ricocheting from one health crisis to another. The family is broke from constantly having to pay for medical treatments and procedures. Kate’s been miserable for as long as she can remember. Older son Jesse is in trouble at school and has taken to petty arson out of neglect. Anna can’t go to camp and pursue her own interests in case Kate gets sick and needs her sister’s blood. I have no idea what it would be like to be living with someone chronically ill, but Picoult’s account feels jarringly realistic; every bit of money and happiness the family had has gone into a black hole of Kate’s illness.
And I found it incredibly unrealistic that the ethics board of a major suburban hospital thought nothing wrong with a thirteen-year-old giving a kidney. The compromised life at thirteen? I only know no (respectable) Australian surgeon would OK those circumstances, but again, I am interested in what people from other countries have to say.
But what keeps coming back to me is Sara’s determination to have Anna donate a kidney. She knows the risks, she just doesn’t seem to care. I know it must suck to be in that position and I hope I never will be in a position to need one child to give life to the other and hope like hell it doesn’t kill them both, but Sara constantly comes across as caring far more about Kate then Anna.
In the final court scene, it’s revealed that Kate was tired of living this half-life and wanted to die, and didn’t want Anna’s health to be compromised along with it. She engineered for Anna to sue for emancipation, because she didn’t want to admit to their mum that she wanted to give up. Whatever Picoult intended, my response was ‘so, now BOTH girls are too scared to tell her what they want?’
And this is where the book and film diverge. In the film, Kate dies, and Anna, Jesse, Sara and Brian go on as best they can. I thought that was the more realistic of the two. In the book, on the way home from the court decision that says she doesn’t have to give a kidney, Anna and her lawyer are in a car crash that results in Anna’s death, and guess what? Kate gets the kidney!!! Yay! I don’t know what Picoult meant to say, but my interpretation was ‘that’s what you get for banking one daughter’s health against the other, thinking they will both be OK, you selfish woman’.
I could never feel for Sara, and I think that’s where Picoult went wrong. Diaz brings something more human and desperate to Sara, but the book’s Sara just comes across as as a single-minded person who doesn’t give a crap who’s she’s hurting so long as she gets her (idealistic) way.
I think Picoult has a lot of talent as a writer (Nineteen Minutes, House Rules). But I also think she often takes on an emotive issue and then gets lost in exploring them and reduces her original idea to something far less great than it could have been. That feels like the case here with My Sister’s Keeper.
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Western Australia has laws against live donation? What the fucking fuck?!?
… Okay, I’m admittedly biased here, as I am a renal patient. The only reason I’m not still on dialysis is that my awesome cousin was determined to give me one of her kidneys, and we had the surgery done in December last year. Her recovery was actually quite a bit faster than mine.
Live transplants have many, many advantages over cadaverous transplants. While I certainly agree with laws prohibiting minors from donating, to prohibit people from donating period is just as much controlling people’s right to choose what to do with their bodies as the most draconian anti-abortion laws.
Regarding the book, I haven’t read it. Picoult’s run writing Wonder Woman was bad enough that I have no desire to read her novels.
Patrick McGraw(Quote) (Reply)
I never read the book, but one of my main issues with the movie was that since Anna’s lawsuit was manufactured, what does that say about her if she had “just” wanted the rights to her own body? Would that make her a “selfish bitch”? Is the movie only portraying her as sympathetic because she doesn’t really want to keep her kidney just because she’s tired of it all? I got the impression that choosing, you know, bodily autonomy over full-time sacrifice was really vilified, and that the whole “do what YOU want” vs. “do what the FAMILY wants/needs of you” argument is incredibly gendered and that, unless you are actively dying, there is only one right answer. Ick.
Also, that Kate just wanted to die, but used Anna, her little sister, to protect herself and her parents in the same way her parents had been using Anna to protect themselves and her– how does that make her a good person? It could be excused because Kate is a teenager, and one going through some really serious issues, in the midst of an incredibly messed-up family dynamic, but still. Even when Brian attacked Anna for being dishonest with their parents, I felt like that was some really misguided anger. Anna just seemed incredibly put upon by her whole family. And no one is angry at Kate. Kate, who has sacrificed so much by continuing to live, and who, even in her “selfish” act of dying, “gives” her sister the right to a life of her own.
Not that being unable to choose to die isn’t a sacrifice, but the movie, at least, portrayed Kate as an Ideal Girl, even in her (relatively idyllic, if tragic) teenage romantic encounter. I think if there was a statement behind all of that, if Kate had really just been put on a pedestal by her parents and wasn’t a perfect darling who needed saving and protecting MORE than her broken and flawed siblings, we should have been shown more of her failings (say, fighting with her siblings, or bad habits that she had) than her hiding behind Anna in her desire to die (which itself, is presented as a good thing to have done).
nijireiki(Quote) (Reply)
Noting, please, that I have spent the last four hours reading news article after news article about every disabled child murdered by his or her parent in Canada since 1994:
Oh yes, I can see an ethics board approving that. A hospital in Canada was quite happy to take non-terminal infant Kaylee Wallace off a respirator so her heart could be transplanted when she died. It’s been over a year, and the last I heard she was still alive – almost like her “terminal condition” wasn’t actually terminal.
I do live with someone not only chronically ill, but with a degenerative condition (Marfan Syndrome – the wiki article looks fairly good should you be curious), as well as cancer and its related treatments. It really isn’t a black hole that sucks all the happiness out of a family’s life. I don’t know if Picoult has a family member with a chronic illness or disability, but that hasn’t been my experience of it, nor the experience of most of the people I have talked to about it. It’s just a very common narrative that’s used in both fiction and in the news media, and it has a very negative impact on the lives of people with disabilities and their families.
These sorts of narrative disturb me because so often the only narrative for people with disabilities are “plucky mascot” or “terrible burden”, or, it seems in this case, “conundrum”. It’s not really reassuring.
Anna(Quote) (Reply)
This is an issue where consent is a factor. I lost my sister not long ago, and even knowing how it would compromise my life and activities, if all it took was giving up a kidney to have her back I’d be willing to carve it out myself.
But as said, Kate’s illness was a black hole. The kidney was a stop-gap measure, not a cure. At best it would extend Kate’s life another few years, but possibly not even that.
The mother’s feelings should have been irrelevant. The only two factors that should ever have come into play is that Anna didn’t want to give up her kidney, and even if she was willing, Kate didn’t want the kidney.
If Anna made an informed decision to give up a kidney that Kate wanted, and the medical board said no, then the medical board would be in serious error and as far as I would be concerned, they would have blood on their hands. Their job would be to ensure Anna is not being taken advantage of, not to render her irrelevant.
But since Anna made an informed decision not to give up the kidney, the medical board’s job is to ensure her mother does not override her even if that means requesting that the mother be escorted off hospital grounds and summoning Child Protective Services.
GardenGoblin(Quote) (Reply)
I’ve read the book but not seen the movie. The book bothered me quite a bit. I could not at all empathise with Sarah; I agree with you about how she came across prioritising Kate over Anna.
I was a little angry that it turned out that the reason Anna’s lawsuit was that Kate no longer wanted to live that way. It was Anna’s great expression of her agency as a separate individual from her sister. Oh, never mind, no; it was just Anna doing what she thought Kate wanted. (I agree with another commenter that if that hadn’t been the reason, Anna would’ve been too selfish–at least in Picoult’s eyes.)
I came away from the novel feeling betrayed by Picoult. She hits some great and painful notes, but in the end, it all seems to justify existing values that I think need changing.
The book’s ending made me bawl my eyes out and filled me with rage at Picoult. It was horrible and manipulative. For that reason alone, I won’t be reading any more of her stuff. The movie’s ending (I haven’t seen it) sounds like it doesn’t get it right, either. In the car just before the accident, it seems that Anna is about to decide to donate the kidney after all. I didn’t agree with that choice, but I did agree with Anna’s right to have that choice to make. Picoult took that away.
Ginny!(Quote) (Reply)
My sister is a nurse and she disagrees on our laws. She thinks so lomg as a person is 18+ they can give liver, kidney etc. I disagree beccause I know the loss of quality of life a person has fromdonating an organ. Patrick, I’m from a conservative Australian state; I’m actually quite liberal in my beliefs. Just on child donation I get conservative
scarlett(Quote) (Reply)
Yeah, but if someone over 18 would prefer to lose some quality of life from donating an organ rather than lose a PERSON who’s going to die without it – which is typically the case with donations (yes, there are often other measures like dialysis available, but I believe they shorten lifespans compared to transplants), then I think that person should have a right to make that choice.
That’s really interesting – I didn’t know some places had laws against live donations.
Jennifer Kesler(Quote) (Reply)
I was watching an old show from the 70s the other day in which a child’s pony got a broken leg, so the adults shot the pony to death. The child was crying, and a woman reassured him: “Would you want to spend the rest of your life as a cripple?”
In hindsight, I realize what a common narrative that was when I was a kid, but today my jaw just dropped. Especially because in the previous season of that show (which was about a plague wiping out most humans, and what the survivors do to get by), they’d gone to so much trouble to show that a man who could barely walk at all could still be worth feeding and sheltering (in this desperate time where they really can’t feed and shelter everybody), because he could teach the children while others did the work that required walking.
Jennifer Kesler(Quote) (Reply)
Yeah I believe WA is the only Australian state that doesn’t alllow live donations, but I’d have to check – Queensland is super-conservative too. I agree with it in terms of adult donation, but I find live child donation abhorrent. I don’t think they have the grasp to know what they’re signing up for. OK, maybe 16-17, with approval from an ethics board, but definitely not 13, and that’s one of the issues I had with the book; the ethics board was all, yo, 13 is totally cool to donate a major organ.
You might be interested in googling Claire Murray; she was a WA woman who had already had a failed liver transplant and for that reason she wasn’t allowed back on the transplant list. Her sister was willing to donate, but because we don’t allow live donations, they had to go to SIngapore and foot like a quarter mil bill for it. She ended up dying and the family still had to pay the bill. I’m not disagreeing with having to pay the bill, but if they had allowed live transplants in WA it would have been a hell of a lot cheaper.
scarlett(Quote) (Reply)
You raise several good points. I don’t think a person, let alone a CHILD, is being selfish because they want to hold onto an organ. And yeah, Kate is definitely portrayed as the tragic perfect child – although I believe there’s a few scenes which show them fighting but mostly that’s more disagreeing about petty stuff. But mostly what I saw was Kate being afraid to tell her mum, hey, I’ve had crappy health all my life, and I prefer to die than risk my sister’s health; Sara just came across as a controlling jerk who was determined to have her own way, health and happiness of her children be damned.
scarlett(Quote) (Reply)
Exactly. The fact the ethics board were OK with it was a huge part of what bothered me. I sort of got that Sara was willing to delude herself that both daughters would be OK, but that’s what we HAVE independant boards for. I justcould notbelieve they would be fine with having a thirteen-year-old donate a kidney.
Edited: I think it’s a VERY grey issue when having children – and people with limited intellectual capacity – consent to something as major as organ donation. The other things Anna donated – blood, bone marrow, are replaceable with no long-term health risks, but a kidney? I think you have to be very careful in a situation like that as to what constitutes ‘informed consent’. In this case, Sara was constantly in the background, using emotional guilt to convince Anna – AFTER being told by the courts not to. How real is the informed consent if you have a parent constantly saying ‘do you want you sister to die? Because she will if you don’t give her a kidney?’ Our brains are still developing at thirteen; how realistic was it that Anna fully comprehended the quality of life she was giving up? I’m not saying it’s not possible for a thirteen-year-old to be able to do that, just that I think ethics boards need to be VERY careful about what constitutes informed consent in a case like that.
And in any case – from what I remember, the ethics board universally OKed it. So, what, NO-ONE had an issue with a thirteen-year-old giving up a kidney? I get Sara justifying it, but that’s why we HAVE boards like that; professional who are emotionally detached who can review the potential losses to Anna vs potential gains to Kate. I found it hard to believe that no-one said, actually, I don’t think the gains are worth the risks. And even that they DID universally OK it, not one of them had a problem with the fact she said no? Dude, you wouldn’t take an organ from an adult against their will (black market aside) but you see nothing wrong with doing it to a child?
/end rant.
scarlett(Quote) (Reply)
Ginny, I totally recomend her newest book, House Rules. It has her trademark dumb-ass twist but it explores the life of someone with Aspergers well, I thought. And Nineteen Minutes was realy good.
scarlett(Quote) (Reply)
Scarlett, are you saying that an adult should not have the bodily autonomy to choose that reduced quality of life to help another person?
Patrick McGraw(Quote) (Reply)
Patrick, I’m sorry, I was very tired when I wrote that first comment so I was garbaliing what I grew up to believe living in a conservative state and what I’m slowly coming to believe being exposed to more broad opinions. Yes, I think adults have the right to live donate if they wish. I’m not familiar with the health benefits of recieving from a live donor vs a cadavar but I do get the *reason* we have laws against live donation. The issue I had with MSK is that not only does her mum think she’s selfish for not wanting a minor to donate, but the ethics board sees no problem with it. If an adult wants to do it, they have that right, but to expect it of a child, let alone call them selfish for saying no, I thought was abhorrant.
scarlett(Quote) (Reply)
I live in Austria and over here no Doctor can treat a child medically or use it as donor if the child doesn’t give consent. It doesn’t matter how young the child is, if he/she can comprehend what’s going on and stil says no, then it’s a no-go for the Doctor. Also something as dangerous as kidney donor would probably never be done to a 13-year-old even if the child gave consent.
M.C.(Quote) (Reply)
I thought the book sucked (haven’t seen the movie, but it sounds like I’d prefer its ending). About half of my book group agreed with me, while the other half thought it was just so moving, and we had a lot of rather vigorous discussion about it.
Quick point – Anna is not genetically engineered. This technology is not yet possible. Instead, her parents undergo IVF, and all the embryos created then have a sample taken, so that only one that is compatible with Kate is implanted (odds of about 1 in 4). I ended up looking up the New Zealand laws on this in order to argue with the book club, and Anna would not be conceived here; although pre-implantation genetic testing is done here, ethical committees will only approve it if it is of benefit to the embryo – e.g., to exclude a fatal genetic disease – and not if the only benefit is to another person. We do, however, do live organ donation.
Fin(Quote) (Reply)
I totally shouldn’t ask, but do you have a link or two that lists them? I like to be informed on these cases.
Shaun(Quote) (Reply)
Okay, I see. Yes, minors need legal protection against being pressured to donate organs. For the same reasons they need legal protection against all sorts of other things that adults can choose to do – power imbalance, most obviously. But when it comes to adults, the right to bodily autonomy applies to donating organs just as it does to abortion or sexual reassignment.
The benefits of live donation are very significant. The organs are much more effective, risks of rejection are far lower, and the lifespan of the organ is usually greater by decades.
Patrick McGraw(Quote) (Reply)
I think it’s high times that we grow our organs in the lab.
The Other Patrick(Quote) (Reply)
I haven’t actually read the book, but the reviews I’ve seen on autistic blogs are not that great. Mainly in that Jacob is a caricature, portrays (evidently) every single symptom the author’s seen, takes every expression literally /every/ time, etc. Again, I haven’t read the book, but just reading the interview with her on her website gives me the strong impression she doesn’t really understand Asperger’s Syndrome, even though she spends most of the interview making an anti-vaxxer argument.
Interestingly, too, she says about half the parents she spoke to believe vaccines cause autism and half didn’t. One, that makes me wonder what kind of parents she was talking to, and two, it’s interesting that she apparently didn’t ask any autistics what they thought.
Shaun(Quote) (Reply)
Sorry, I didn’t realise this comment was directed at me when it came in my inbox.
Do you want lists of Plucky Mascots, or lists of news reports wherein PWD are treated as disposable? The former I have, the latter I’d have to generate, but it wouldn’t take long.
Anna(Quote) (Reply)
*sigh* I wish authors would be upfront: We don’t think actual autistics read books! We don’t think actual people with disabilities read books! These books are just for everyone else! It would make choosing books easier.
Anna(Quote) (Reply)
Whatever’s convenient. I don’t really think I need lists of news articles where PWD are treated as disposable–they’re not hard to find–I meant more the actual names of PWD victims for reference.
Shaun(Quote) (Reply)
How do little kids get shots or IVs when they’re sick?!?
Attackfish(Quote) (Reply)
Have you read Extremely Loud and Incredibly Close by Jonathon Saffron Foer? I’m pretty damn sure the main character (who is 9) has AS/autism, but it’s never mentioned in the book. I actually really appreciated that. He just gets to be a character without being marketed as The Autistic Character. The other two POV characters in the book are kind of different, too.
Shaun(Quote) (Reply)
All I’ve got handy right now is a cheerful list of murder victims that is limited to “murdered by one or both parents in Canada since 1993″. I suspect it’s not complete.
Anna(Quote) (Reply)
Whoops, my bad, although I’m sure at some point in either book or movie they talk about Anne being genetically engineered – I know at least once they talk about her being conceieved in a petri dish, maybe that’s what I’m thinking of.
I would have to check to make sure, but I think we don’t allow that kind of IVF manipulation (though we still do IVF treatment, just a case of ‘you get what you get’) for any reasons, although other states do. I recall there was a big case 5-6 years ago when a couple had to go to another state to get an embryo chosen to be a match for their chronically/terminally ill child, and wanted the WA government to foot the bill. I happen to disagree with that kind of argument in general; if a government has a policy not to provide a certain treatment, then they don’t have an obligation to pay for people to have it somewhere else.
And yeah, I think the movie ending was better. I thought it was so tacky how Anna went through all this effort to get her medical emancipation – which I thought was a highly contrived, unrealistic situation anyway – only for her to die anyway and Kate to get the kidney. It made me feel I was being positioned to think Sara got hers for putting Anna in that situation in the first place – so, you want to screw with your daughters health in the hope of saving the other one? Well, HAHA YOU SELFISH COW, now she’s dead!
scarlett(Quote) (Reply)
Really? I still had my issues with how plusible parts were (hasn’t the vacccine theory long been debunked? Would a judge really be THAT insensitive to Jacob’s needs? Would even the most ruthless of lawyers really suggest that Aspergers doesn’t exist and Jacob’s just been a moody teenager?) but I did like how they narrated it from Jacob’s perspective and he could explain how he thinks and how quick to judge many people are about something they don’t know. Had her usually dumb-ass twist though. But I know nothing about ASD so I’ll leave it up to people who DO to be the best qualifiers of its merits. And hell, maybe it just SEEMED good after The Pact and Handle With Care.
scarlett(Quote) (Reply)
I’m sorry if this is a bit off topic – I’m afraid I haven’t read the book and, going by your review, I would definitely not like it!
However, when reading the comments I was a bit surprised by you categorising WA as ‘super-conservative’. Which doesn’t gel with my experience of it. I’ve lived in two places in my life – Perth and a town in the North-Eastern US. Of the two, Perthites (at least the ones I mostly know) are a good deal the less conservative.
Of course, we probably run in different circles and your experience obviously varies, so I had a quick look round. Actually, I randomly chose gay laws as one thing liberals (small ‘l’) and conservatives always seem to disagree on. It does kind of fit both of our arguments. We decriminalised later than Vic, NSW and SA, earlier than TAS or QLD. Anti-discrimination laws much the same time as the rest. Equal age of consent, not till 2002 (earlier than TAS or QLD and later than the rest again).
But where it gets interesting, and makes it difficult to say WA is unequivocally conservative, is the raft of laws for equality regardless of sexuality, which with IVF and adoption laws is more advanced than the rest of the country, on the whole. And while some people must have worked very hard to get these laws through, the fact remains that the WA voters, in general, not only voted in a Labor government that had, iirc, made at least the equal age of consent part of their platform, but also voted it in again at the next election after they had done so.
Look, it’s always more complicated, and I don’t deny we do (as probably does every State and country) have a particular set of conservatives that can behave pretty appallingly, nor am I claiming that even the laws I’m talking about are either perfect or perfectly applied, but we do have a lot of non conservative people in both high positions and just in ordinary, everyday walks of life, and overall, I certainly wouldn’t say we’re that conservative. Some of us are, some of us aren’t.
The other thing I’m wondering about, and checked on, is live organ donation. I found a couple of sources that suggested we do have it – A report from the “STANDING COMMITTEE ON UNIFORM LEGISLATION AND INTERGOVERNMENTAL AGREEMENTS: ORGAN DONATION AND TRANSPLANTATION” and a press release from Kim Hames, the WA Health minister, which mentioned it. But, you quoted your sister saying we should have it, and if she’s a nurse, I’d assume she’d know more about it than I would, and wouldn’t have said that if we did have live organ donation, so can you point me to the legislation banning it, because it does seem a very odd law?
Apologies for going on a bit – apparently I’m a feminist second today, a West Australian first…
Dana(Quote) (Reply)
Haha. There’s nothing wrong with liking the book, even if it is ridiculous (and I don’t know how realistic the portrayal of the people around him is, I was mostly commenting on the author’s grasp of AS), and I hope I didn’t come across like that.
In answer to your question though, yes, the vaccine stuff has been debunked. Andrew Wakefield, the guy who published the original 1998 study that started this whole mess, has been found to have acted fraudently in his study. The Lancet published a complete retraction of his paper, something only done in the rarest of cases, and the British government revoked his medical license in May. Basically he was being paid to create evidence that the MMR vaccine was toxic, and never disclosed this little tidbit.
This is why Picoult’s actual reference of him was kind of funny, since if she bothered to know anything about the topic (beyond what those parents were telling her) she’d certainly know about his conduct. I’m still waiting for the UK to actually prosecute him, though, considering his legal crimes and the amount of harm they’ve done in the intervening 12 years.
Shaun(Quote) (Reply)
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