Cancer lies with who makes the decision. Picoult presents

is a ruthless and destructive illness. If a person had the ability to save
someone with cancer but had to give up part of their life – would they? The simple
answer is of course, but the more complicated answer lies with who makes the
decision. Picoult presents speaking for others as a way of fighting for control
in My Sister’s Keeper through the use
of changing perspectives and symbolism.

Picul’s novel is about the Fitzgerald family. Sara and Brian are parents to
Jesse, Kate, and Anna. Kate was diagnosed with a rare form of leukemia at the
age of two. Neither parent is a match, nor did their oldest child, Jesse,
match. When treatment was not working without the cells of a donor, Brian and
Sara Fitzgerald turned to genetic testing and in-vitro fertilization to have a
child who is a match to be a donor for Kate. This leads to Anna’s conception,
birth, and donation of blood, bone marrow, and other things to help treat
Kate’s cancer. This is problematic because Anna does not have a typical
childhood and every decision made for Anna is in the best interest of Kate.
Anna was unable to consent to these procedures because she was only five years
old when she had to undergo a procedure for her sister. When her mother asks
her to donate a kidney to Kate when she enters renal failure, Anna decides to
sue her parents for medical emancipation.

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use of multiple perspectives parallels the idea of speaking for others. All of
the major characters are heard from directly except for Kate. While the
Fitzgerald’s have made decisions on Anna’s behalf, they have all been in
relation to Kate. Any medical decisions for Kate have been made by someone
else. Sara Fitzgerald is Kate’s biggest advocate which is good but also
problematic. She makes decisions for Kate based on her position as Kate’s
mother and not keeping Kate’s desires in mind. This shows that regardless of
who is speaking for Anna – they all are speaking for Kate and making decisions
on her behalf. She is not incapacitated – she has cancer. Picoult is relaying a
greater message about how cancer patients are treated. Sara Fitzgerald
discusses Kate’s first love and how she cannot get Kate to agree to undergo a
procedure. Kate wants to see the boy she likes – and she cannot do that in
reverse isolation (Picoult 312). While the hospital staff allows Kate to modify
her treatment it is a stressor for Sara because her daughter is putting herself
at risk by manipulating her treatment. When the object of Kate’s affection (who
is also a cancer patient) dies, Sara cannot bring herself to tell Kate – for
she fears it will drive Kate to keep from fighting (Picoult 321). There is a
manipulation of information to best protect what Sara thinks is her daughter’s
best interest. Sara allows herself to feel better before she gives Kate the bad
news – this is a clear example of how speaking for others can be misconstrued
as controlling others. Sara had the best intentions when withholding
information but she alienated herself from her daughter in the process.    
 Both Brian and Jesse Fitzgerald use fire
as a tool for coping with the turmoil in their lives. Brian Fitzgerald is a
firefighter and he controls fire for a living – but he cannot control Kate’s
illness. For example when he finds out Jesse set a fire in a building and Brian
makes the decision to not tell the police he says “Maybe it’s because
Jesse isn’t all that different from me, choosing fire as his medium, needing to
know that he could command at least one uncontrollable thing (Picoult 331).
Fire is important to this book because it is something that can be studied and
controlled, but at the same time can kill people in the process. This is a
metaphor for cancer and while it can be researched and studied people will
still die from it. The Fitzgerald men seek out fire as a way to maintain
control over something when it seems impossible in any other aspect of their

When a parent speaks for their child they have to make sure
they do not cross the line between advocacy and controlling. She worked as a
lawyer before becoming a stay at home mom. Sara works tirelessly to keep her
daughter, Kate, alive. Through this, she fails to be a mother to Anna and
Jesse. Through speaking for others she does not focus on how she is impacting
the people around her. Throughout the novel Anna discloses how her conception
was driven by Kate’s illness and had Kate not been sick – Anna would not have
been born. Anna knows that she has genes specific to donating cells and other
things to her sister. Picoult brings attention to how this puts a strain on
Anna’s relationship with her parents when Anna says “if your parents have you
for a reason, then that reason better exist. Because once it’s gone, so are
you” (Picoult 8). Anna is grappling with more than teenage angst throughout the
novel, but the weight of her sister’s health. Sara and Brian Fitzgerald made
decisions about Anna and for Anna that she did not have the power to agree to.
This is an example of how Picoult presents parents stopping at no cost to keep
their children alive. Picoult also reveals the nuances of these decisions and
how they can impact a family – and an individual in the long term.    

Picoult presents that seeking can control over one’s life
can be a source of guilt. Throughout the novel, Anna discloses her guilt in not
wanting to donate anything else to her sister. This guilt is caused by her
being manipulated by her family and her saving Kate is when she is the most
important. Picoult confirms this when Sara finds out about Anna suing for
medical emancipation; “My sister’s in pain, and I’m relieved. What does that say about me?” (Picoult 52). Anna
is conflicted in that she wants her sister to live but she does not want to
continue making sacrifices for her. The main reason for the lawsuit is for Anna
to gain control over her body and with the need for control comes guilt. 

in the novel, it is revealed that Kate requested that Anna sue for medical
emancipation as a way to end Kate’s suffering. This moment in this book is
where speaking for others can allow individuals to have their voices heard.
Picoult addresses this during the lawsuit when Judge DE Salvo asks Anna what
Kate wanted her to do. Anna says, “She asked me to kill her” (Picoult 388).
This part of the story highlights Anna and Kate’s relationship and how Kate
relies on Anna to be her voice. Anna and Kate are incredibly close throughout
the novel – Picoult highlights how these sisters love and rely on each other. There
is a distinct contrast between Sara’s relationships with each of her daughters
and between her daughters. Sara wants what is best for Kate and does not seem
to consider the greater impact on Anna when she asks her for her kidney.

impact of not hearing from Kate directly until the end of the book is telling
of how body. There is irony in the fact that the book revolves around Kate,
while Kate’s perspective is never heard Picoult displays this clearly when the
trial hits its pinnacle point and it is revealed why Anna initiated the
lawsuit. Kate is not heard until the Epilogue of the novel and how her family
has recovered following Anna’s death. Kate discusses her own guilt regarding
Anna’s death and how she feels responsible for what happened to her sister
(Picoult 421). Anna died in a car accident the day after she got the verdict
from her court case. Kate feels guilty because had she not had Anna sue her
parents she would not have died in the car accident. This sentiment from Kate
mirrors the guilt Anna felt when she was filing her lawsuit against her
parents. She did not want to donate her kidney but did not want Kate to die.
Because Kate felt that her voice would not be heard by her mother she took
drastic measures to stop her kidney transplant. Kate had been sick most of her
life and wanted to stop having procedures. Anna and Kate are not different in
having their parents make choices on their behalf and while it is not uncommon
for parents to make decisions for their children Anna and Kate are not typical

Picul’s book is one of fiction – but it draws attention to
the idea of exploitation. G. Thomas Courser wrote in “The Cases of Oliver
Sacks: The Ethics of Neuroanthropology” about how illness should not be
exploited. While Kate is not exploited because of her illness – Anna is. Anna’s
entire existence has relied on the fact her sister has cancer. Because of this,
her body is being used as a harvesting site for her sister – regardless of the
intentions, her parents had. The dictionary defines exploitation as “the
action or fact of treating someone unfairly in order to benefit from their
work.” Kate is benefiting from Anna’s existence on a scale that is highly
unusual. Couser would find Anna’s conception to be problematic because the
Fitzgerald’s are creating a child for the sole purpose of saving the daughter
they already have. While this action has good intentions it raises issues as
the child in question (Anna) gets older and realizes she truly does exist in
relation to her sister. Couser’s literary theory connects to Picoult’s work –
not what Picoult does, but what she presents the characters doing and how it is
problematic. In Couser’s work, he suggests that “narrative closure”
(Couser 10) is too neat. It is not real life to have a happy ending every time
or for things to wrap up nicely. Picoult’s work would please Couser because
while Picoult depicts Anna winning the lawsuit and wraps up her narrative it is
not a perfect ending.

are several aspects of control that are examined in My Sister’s Keeper. First is the control that comes with speaking
for others. The second type of control is the control over one’s own body. Anna
was born to save her sister and for years she has not been the sole controller
of her body. This connects to the idea of cloning and the ethics of creating
humans for the purpose of donating their organs. Cloning and donating organs is
something that is shown in popular culture and sci-fi movies. These movies deal
with the implications of what happens when individuals are aware that they are
alive to be an organ farm. The ethics of cloning are not mentioned in depth in
Picoult’s piece which is one of the most problematic parts of Picoult’s piece.
The ability to conceive a child to save another is a great task that is being
placed on an unborn child’s shoulders. While one might want to live at all
costs – be it okay to sacrifice someone else’s life to continue living? 

novel is one that tackles the issues of speaking for others regardless of
whether they can speak for themselves. The ethics of speaking for others are
complex and Picoult does not answer the ultimate question of who is right and
who is wrong. Speaking for others is presented as something that challenges
ethics and is greater than a scientific answer.