The main theme of My Sister’s Keeper revolves around the question of medical ethics, particularly as it relates to parental love. Though the author, Jodi Picoult, focuses largely on family dynamics, the family dynamics that come into play in the story revolve around the ethical considerations related to genetic engineering, stem cell research, and the creation of "savior siblings." Anna’s attorney built a case around the question of medical ethics. He questioned the morality of parents whose decision to have a child rested solely on the ability of that child to serve as a tissue donor. When Anna’s parents planned to force Anna to give her sister a kidney, Anna sought help from an attorney to protect herself. He sued for medical emancipation for his client, arguing that she was being subjected, without her consent, to medical procedures that put her at risk and reduced her quality of life.
Genetic pre-diagnostics are being used increasingly in medical practice to pre-select fetuses that are free of genetic diseases. Advances in medical science that have allowed people to manipulate the breeding process in this way have paved the way for the creation of designer babies—babies designed to have certain physical traits, or in this case, babies designed to have organs and tissues that make them suitable donors. These babies are referred to as “savior babies,” and there have been real savior babies as well as Picoult’s fictional Anna. Real savior babies have been used as donors of umbilical cord blood stem cells at birth, of bone marrow, and of organs. My Sister’s Keeper raises questions as to how far genetic engineering can go and should go, and how in the face of advancing medical possibilities, we can weigh the rights of dying children with the rights of their savior siblings.