In one version of my future, I attend graduate school so I can get a PhD in Philosophy, focusing on biomedical ethics. I find the topic endlessly fascinating, and full of such interesting and open-ended questions. So I can’t believe that I waited this long to read this book. I’d really like to dive into the subject matter of the book, so if you’re planning on reading it and want to avoid all manner of spoilers, here’s my one sentence review: it’s good, it grapples with interesting issues, and the version on Audible is probably the first time I’ve really enjoyed a novel as an audiobook. Also – don’t watch the movie version (which I’ve been doing while writing this review). It’s just so different, and the choices they make really take away from the story the book is trying to tell.
The basic premise of the book is that Anna is seeking medical emancipation from her parents, who want her to give a kidney to her dying sister Kate. Anna is 13, Kate is 16, and their older brother Jesse is 18. Anna was conceived as a genetic match for Kate after Kate was diagnosed with leukemia at age 2. The book is told in alternating chapters from many characters perspectives: Sara, the mother; Brian, the father; Anna; Jesse; Campbell, the attorney hired by Anna (pro-bono) to take on the case; and Julia, the guardian ad litem who is tasked with reporting to the court on what is best for Anna. The audio book really excels here because each character’s chapter is voiced by a different voice actor, which brings a real richness to the storytelling.
One thing the book does extremely well is telling us Kate’s story without ever giving us Kate’s perspective on things. It’s a bold choice, considering she’s the reason for the situation. But Ms. Picoult knows what she’s doing – she wants us to all to consider what the rest of the family goes through, because they all revolve around Kate and her constant illness. Jesse’s chapters focus on the fact that he hasn’t had really any attention, and that he’s dealt with by becoming an arsonist (perfect choice, since Brian, the father, is a fire fighter). Campbell and Julia have a side story, a history, that both seems a bit unnecessary but also serves to remind us that people have lives that go on outside of this family. The parents’ chapters are heartbreaking and brutal, especially Sara’s chapter where she describes giving birth to Anna. She’s so focused on saving the umbilical cord blood that at no point does she express any interest in her newborn. I don’t doubt that Sara loves all of her children, but I don’t know how she can love them all with the same passion she carries for saving Kate.
Anna’s chapters are challenging because she’s only 13, and she is so torn between loving her sister desperately and wanting a life of her own. Anna’s been called on to save her sister repeatedly, through stem cell donation, bone marrow transplants, and other donations. It’s affected her ability to do things, like go away to summer hockey camp (because her sister might need something from her). Anna and Kate are really close, though, so you know Anna is internally conflicted about wanting to save her sister and wanting a life for herself.
The issues that Ms. Picoult is grappling with in this book are so numerous. Is there something wrong with genetically engineering a child with the express purpose of saving another child’s life? Can the parent love the engineered child in the same way – can he or she ever see the child as an independent being, as opposed to being the one who is responsible for saving the other child’s life? What about other siblings in a sick child’s family? Even outside of all the issues of the sister being asked to contribute to and save the other sister’s life, what happens inside a family where one child is chronically, likely terminally, ill? Is it wrong of the other children to want to have lives, even if their ill sibling can’t? And how can a parent be asked to provide opportunities to the healthy children when they are so focused on saving the sick one? I can’t imagine being in that situation – it seems so horribly challenging, and exhausting, and unfair. And finally, what about the child who wants to make decisions for herself and stop being tied to her sister? It seems so easy to say ‘it’s just a ______’ (blood donation, bone marrow donation, etc.), but really, there’s got to be a limit. And can we expect a child, or a teenager, to pass those limits?
I don’t know the answers to these questions. But they’re interesting, and as science progresses, we’re going to have to explore more of them.