Savior Siblings: A Case Study Based on My Sister's Keeper
By Kari Kjos
My Sister's Keeper, a bestselling novel by Jodi Picoult, poses many ethical issues, specifically on pre-implantation genetic diagnosis, "designer babies," savior siblings, and child vs. parent autonomy. To set up a discussion on the ethical issues My Sister's Keeper raises I showed selected scenes from the 2009 film (directed by Nick Cassavetes) and then presented relevant science background information.
This discussion module includes
- a description of My Sister's Keeper
- a list of selected scenes from the movie
- a PowerPoint presentation on science background information
- and discussion questions.
I hope that this module is a useful resource for setting up thought-provoking discussions on My Sister's Keeper in the future.
My Sister's Keeper Movie Summary
My Sister's Keeper is the story of Anna Fitzgerald, a "designer baby," who was genetically designed, conceived, and born to be a perfect genetic match for her older sister, Kate, who suffers from a rare childhood leukemia. At birth, Anna donates umbilical cord blood to Kate, but as Anna grows up she donates more blood, marrow, and stem cells to her sister to keep her alive. When Anna is 13, her sister enters renal failure and her parents expect Anna to donate a kidney to her sister. In response, Anna enlists the help of an attorney to sue her parents for the rights to her own body. The story follows the family's struggles as Anna sues for medical emancipation from her parents.
Selected Movie Scenes: You Should Follow the Scenes/Time Sequences on the DVD
We've selected the following scenes to allow for a class or discussion group to get a good sense of the overall story without watching the whole film.
- Show the first 3:25 minutes of the movie (stop when start scene of family at the dinner table). This scene introduces the Fitzgerald family and shows Anna explaining how she is a designer baby.
- On the DVD, skip to the next scene of Anna meeting with lawyer Campbell Alexander and play the 2:35 minute scene. In this scene, Anna tells the lawyer that she wants to "sue for the rights to her own body."
- Before showing the next scene, explain that the movie now shows scenes from the past when Kate was first diagnosed with acute promyelocytic leukemia as a 2 year old. After Kate did not respond to treatment, the doctor held a meeting with the Fitzgerald family.
- On the DVD, skip to the next scene of the family meeting with the doctor. Show 4:40 minutes of the movie. This clip shows the family meeting with the doctor, a scene in the hospital when the mom finds out Anna is suing for medical emancipation, and a scene of the family at the dinner table when Anna explains why she doesn't want to donate her kidney to Kate.
- On the DVD, fast forward to the scene where the mom and the dad are talking at the fire station, and show the next 3:20 minutes of the movie. This clip shows the mom and dad arguing about what to do about Anna's lawsuit, and a scene of the mom storming into Campbell Alexander's office.
Science Background Talk
- The PowerPoint presentation goes over science topics relevant to the movie:
- Acute promyelocytic leukemia (APL)
- APL Treatment
- "Savior Siblings"
- In vitro fertilization (IVF)
- Pre-implantation Genetic Diagnosis (PGD)
- Risks of donating a kidney
- The PowerPoint takes approximately 10-15 minutes to present.
My Sister's Keeper Discussion Questions
- Given what you've just seen, which character are you most sympathetic to? Why?
- Imagine you are the mother: while Kate is dying, you discover that Anna refuses to give Kate the last possible life-saving treatment. How would you react? How would you try to keep your family together?
- Do you think it is ethical to design and conceive a child that meets specific genetic requirements?
- If so, is PGD ethical in all cases? (prevent miscarriages, prevent inheritable genetic diseases, sex selection for social reasons, etc)
- If not, do you believe there should be specific exceptions - such as saving another person's life - or is this just a "slippery slope"?
- Knowing what you now know about PGD, do you agree with the parent's choice to "design" Anna to save Kate?
- Is it ethically ok to screen embryos for desired genetic traits, and reject the "undesired" embryos?
- How does the knowledge that Anna was conceived to save Kate affect Anna's and Kate's perceptions of themselves, and their relationship with each other? For instance, you might consider the following:
- Will Kate feel guilty knowing that Anna was created to save her life?
- What if Anna can't save Kate? Will Anna face lifelong psychological damage?
- Does Anna feel objectified as a "spare parts baby"? Does Kate feel objectified as a sick person?
- Do you think the parents went too far in their concern for Kate by making Anna a savior for Kate? When is it too far to save one child by using the body of another? By taking umbilical cord blood? Bone marrow transplants? Kidney donation? After Anna has spoken up in opposition to any further use of her body?
- Recall the physician in the movie who recommended PGD, an ethically questionable procedure, "off the record." If you were a physician, would you recommend PGD to a couple in a similar situation?
Kari Kjos is a senior at Santa Clara University and a Hackworth Fellow at the Markkula Center for Applied Ethics.