The question of bodily autonomy and its limits is the core issue of My Sister’s Keeper. The novel’s protagonist, 12-year-old Anna Fitzgerald, attempts to assert agency over her own body when she sues for medical emancipation from her parents in order to avoid donating her kidney to her older sister, Kate, who is suffering kidney failure after a decade of battling acute promyelocytic leukemia. The dilemma of the two sisters’ conflicting interests forms the crux of the novel’s conflict: although Kate deserves a chance to live, she is so weak that she might not even survive the procedure, and living with one kidney could affect Anna’s quality of life. For example, Anna is a hockey player but would not be able to play contact sports with only one kidney.
The intricacies surrounding Anna’s lawsuit become clearer when her case reaches the courtroom in the second half of the novel. Anna’s lawyer, Campbell Alexander, defends her by highlighting the slippery slope that forcing her to donate an organ against her will would create. For instance, at one point, he asks Kate’s oncologist, Dr. Chance, if it would be acceptable to sacrifice Anna if scientists came up with a cure for Kate’s cancer that required Anna to donate her head. While such a hypothetical might seem like a gross exaggeration, it gets to the core question behind Anna’s predicament: should a person be forced to sacrifice any part of their body for another, and if so, where is the line? The novel does not explicitly answer this question, instead challenging readers to think about the difficult, messy interplay of emotions and ethical quandaries that accompany such considerations.
Bodily Autonomy ThemeTracker
Bodily Autonomy Quotes in My Sister’s Keeper
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 previous 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 explained 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.
I tap my pen on the desk, and Judge—my dog—sidles closer. “What happens if you don’t give your sister a kidney?”
“She’ll die.”
“And you’re okay with that?”
Anna’s mouth is set in a thin line. “I’m here, aren’t I?”
“Yes, you are. I’m just trying to figure out what made you want to put your foot down, after all this time.”
She looks over at the bookshelf. “Because,” she says simply, “it never stops.”
“For God’s sake, Anna,” my mother says. “Do you even realize what the consequences would be?”
My throat closes like the shutter of a camera, so that any air or excuses must move through a tunnel as thin as a pin. I’m invisible, I think, and realize too late I have spoken out loud.
My mother moves so fast I do not even see it coming. But she slaps my face hard enough to make my head snap backward. She leaves a print that stains me long after it’s faded. Just so you know: shame is five-fingered.
It would solve a thousand problems if I rolled the Jeep over an embankment. It’s not like I haven’t thought about it, you know. On my license, it says I’m an organ donor, but the truth is I’d consider being an organ martyr. I’m sure I’m worth a lot more dead than alive—the sum of the parts equals more than the whole. I wonder who might wind up walking around with my liver, my lungs, even my eyeballs. I wonder what poor asshole would get stuck with whatever it is in me that passes for a heart.
The baby’s head slips through the seal of my skin. The doctor’s hand holds her, slides that gorgeous cord free of her neck, delivers her shoulder by shoulder.
I struggle to my elbows to watch what is going on below. “The umbilical cord,” I remind him. “Be careful.” He cuts it, beautiful blood, and hurries it out to the room to a place where it will be cryogenically preserved until Kate is ready for it.
For a minute I look at [Anna]. What would I do, if I found out that Izzy needed a kidney, or a part of my liver, or marrow? The answer isn’t even questionable—I would ask how quickly we could go to the hospital and have it done.
But then, it would have been my choice, my decision.
[Kate] sprinted, and nearly had it, but then Jesse took a running leap and slammed her to the ground, crushing her underneath him.
In that moment everything stopped. Kate lay with her arms and legs splayed, unmoving. My father was there in a breath, shoving at Jesse. “What the hell is the matter with you!”
“I forgot!”
My mother: “Where does it hurt? Can you sit up?”
But when Kate rolled over, she was smiling. “It doesn’t hurt. It feels great.”
My parents looked at each other. Neither of them understood like I did, like Jesse did—that no matter who you are, there is some part of you that always wishes you were someone else—and when, for a millisecond, you get that wish, it’s a miracle. “He forgot,” Kate said to nobody, and she lay on her back, beaming up at the cold hawkeye sun.
I’m a coward. There are times when my shift is over that I’ll stay and roll hose, or put on a fresh pot of coffee for the crew coming in, instead of heading straight to my house. I have often wondered why I get more rest in a place where, for the most part, I’m roused out of bed two or three times a night. I think because in a firehouse, I don’t have to worry about emergencies happening—they’re supposed to. The minute I walk through the door at home, I’m worrying about what might come next.
I could ask [Kate] if she has talked to the nephrologists about a kidney transplant, if she has any particular feelings about undergoing so many different, painful treatments. But this is exactly what Kate is expecting me to ask, which is probably why the question that comes out of my mouth is completely different. “What do you want to be when you grow up?”
“No one ever asks me that.” She eyes me carefully. “What makes you think I’m going to grow up?”
“What makes you think you’re not? Isn’t that why you’re doing all this?”
Just when I think she isn’t going to answer me, she speaks. “I always wanted to be a ballerina.” Her arm goes up, a weak arabesque. “You know what ballerinas have? […] Absolute control. When it comes to their bodies, they know exactly what’s going to happen, and when.”
I decided one day to force myself into imagining what it would be like after Kate died. That way, […] when it really happened, I’d be ready.
I kept at it for weeks. […] There were entire days when I did nothing but cry; others where I felt like I’d swallowed a lead plate; some more where I worked really hard at going through the motions of getting dressed and making my bed and studying my vocab words because it was easier than doing anything else.
But then, there were times when I let the veil lift a little, and other ideas would pop up. Like what it would be like to study oceanography at the University of Hawaii. Or try skydiving. Or move to Prague. Or any of a million other pipe dreams. I’d try to stuff myself into one of these scenarios, but it was like wearing a size five sneaker when your foot is a seven—you can get by for a few steps, and then you sit down and pull off the shoe because it plain hurts too much. I am convinced that there is a censor sitting on my brain with a red stamp, reminding me what I am not supposed to even think about, no matter how seductive it might be.
You might remember the recent case of the firefighters in Worcester, Massachusetts, who were killed in a blaze started by a homeless woman. She knew the fire had started and she left the building, but she never called 911 because she thought she might get into trouble. Six men died that night, and yet the State couldn’t hold this woman responsible, because in America—even if the consequences are tragic—you are not responsible for someone else’s safety. You aren’t obligated to help anyone in distress. Not if you’re the one who started the fire, not if you’re a passerby to a car wreck, not if you’re a perfectly matched donor.
What if I was the one who was sick? What if Kate had been asked to do what I’ve done? What if one of these days, some marrow or blood or whatever actually worked, and that was the end? What if I could look back on all this one day and feel good about what I did, instead of feeling guilty? What if the judge doesn’t think I’m right?
What if he does?
I can’t answer a single one of these, which is how I know that whether I’m ready or not, I’m growing up.
“I’m sick of waiting for something that’s going to happen anyway. I think I’ve fucked up everyone’s life long enough, don’t you?”
“But everyone’s worked so hard just to keep you alive. You can’t kill yourself.”
All of a sudden Kate started to cry. “I know. I can’t.”
It took me a few moments to realize this meant she’d already tried before.