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.

In Jodi Picoult's My Sister's Keeper, Anna Fitzgerald is brought into the world by means of in vitro fertilization as "savior sister." Savior siblings are always in vitro because if the conception occurs outside the body, zygotes, or the initial cells, can be genetically tested. In this way, it will be known whether the savior sibling's organs and cells will be compatible with the sibling who will need them. With such a designed birth, there are social issues, of course.

• The Ethics of Breeding a child for design

Because Kate Fitzgerald, Anna's sister, suffers from promyelocytic leukemia, cancer of the blood and bone marrow, Kate's doctor makes an informal suggestion to Kate's mother about giving birth to another child who could be a savior sibling; this suggestion is made informally because a formal suggestion would constitute a violation of medical and legal ethics and the physician would lose his license to practice medicine.

On the parents' parts, there is the question of selective breeding. Since the baby is to be born so that it can be a "loaner" to the ailing sister, the implication is that zygotes are rejected if they fail the genetic match-up tests. Also, the savior sibling can become a mere "laboratory experiment."

• The Ethics of using a sibling's body as a supplier for another sibling

In both the book and the movie version, Anna learns that she is going to be asked to donate her kidney to her sister, and, in the book her sister requests that she not do so; in the movie, Anna does not want to donate any body part, so she hires an attorney to sue for partial termination of parental rights. Here the question arises if it is morally correct to make a child donate blood or body parts to a sibling. At one point, the justification for this type of operation is made for Kate Fitzgerald,

"It's about a girl who is on the cusp of becoming someone.. A girl who may not know what she wants right now, and she may not know who she is right now, but who deserves the chance to find out.” 

• The dilemma of Genetic Engineering

If babies can be designed to fit the needs of siblings, what is to prevent further genetic engineering? Certainly, the potential for a Brave New World presents itself as one family proceeds to genetically reproduce a sister for Anna, a genetic copy for her business. What, then, is the next step?

• The rights of the "savior sibling" 

Does the minor child have a right to deny the parents' argument that he/she donate cells or organs to the sibling? In the narrative of Picoult's Anna hires a lawyer to sue for partial termination of parental rights. 

On the other hand, do the parents have a right to infringe upon other's lives for the sake of saving their child's life?

Jodi Picoult's novel My Sister's Keeper explores several different moral issues. First, we have the moral issue surrounding Anna's birth. You will need to think about the morality of Anna's parents specifically designing a baby to be a match for Kate.

Second, there is a strong moral theme regarding the morality (or lack thereof) of Anna's parents continuously using Anna's body as a resource for Kate. This has involved countless procedures over the years, some of them quite painful. And now Anna's parents are insisting that she give her sister a kidney.

Anna, on the other hand, desires her medical freedom. She wants to have a say in how her body is being used, and she sues her parents for medical emancipation. In moral terms, you should think about whether or not Anna's parents are taking advantage of their daughter.

Finally, think about Kate's desire to die and how she has influenced Anna into starting the lawsuit. There is a moral dilemma here as well, and we are invited to reflect upon how much medical treatment is too much.

Jodi Picoult's My Sister's Keeper introduces the reader to Anna Fitzgerald, a child born with the express purpose of serving as a bone marrow, blood, and organ donor for her sister, Kate, who suffers from acute promyelocytic leukemia. Throughout the novel, Picoult utilizes various literary devices to paint a picture of the characters, build suspense for the reader, and create an emotional reaction, all of which are tenets of her writing style.

Multiple Points of View

Many of Picoult's novels utilize the technique of allowing each character the opportunity to tell parts of the story from their point of view. Each chapter changes the narrator, and each narrator speaks in the first person, relegating the other characters to auxiliary roles in that section of the novel.

In the case of My Sister's Keeper, this gives the reader an opportunity to dispell myths about each character created during the narration of a different character. For example, Anna's life may seem tragic when narrated by the girl who was born just so her sister could live. When Anna tells her story, the reader feels sympathy for her and anger at her parents for forcing her to give parts of herself to Kate. When Kate tells the story, however, the reader sees the young woman who has been sick her entire life and how much she loves her little sister. When their mother narrates, the picture becomes clearer still: she is a mother who loves her daughters and is constantly torn about how to keep them both happy and alive.

Plot Twist

Throughout the story, the reader hopes that Anna will win her court case and no longer be forced to donate organs to Kate. The reader may hope that Anna will decide to donate anyway, but there is a general feeling that Kate may die as a result of Anna's choice. At the end of the book, after Anna has won her case, she heads to the hospital in Campbell's car. They discuss who she will be as an adult, and the one thing Anna knows is that she wants to be Kate's sister. She seems to decide to donate her kidney to Kate even though she does not have to, proving she is brave and mature enough to be in charge of that decision.

The next thing we know, there is a car crash, and Anna is a victim. Anna's kidney is donated to her sister, and Anna becomes the one to die. The twist in the story comes because it is something the reader never imagined would happen. After spending the entire book falling in love with Anna, she is gone, and her sister lives on instead.

Symbolism

Symbolism is a device used by most authors most of the time, even if only in small ways. While Picoult uses the device throughout My Sister's Keeper, it is never more prevalent than in the final chapters leading up to the crash. As each character narrates, he or she mentions rain. The fact that it is raining, or has rained, serves as a lead-up to the car crash that happens in the rain. The rain is significant to different characters for different reasons, but it ultimately represents a fresh start—a clean slate. Had Anna survived the crash and donated her kidney to Kate, they would have had a fresh start as sisters. Instead, Kate receives Anna's kidney and lives on to have a fresh start of her own.

The key literary device in 'My Sister's Keeper' is the use of multiple narrators. Although the story is largely centered around Anna's decision not to consent to the kidney transplant which will save her older sister's life, we are also given the first person perspectives of the rest of the characters involved: Kate, Anna's sister; Jesse, their older brother; their parents Sara and Brian and Kate's lawyer, Campbell Alexander. Through these individual accounts we see that each character has a fierce conviction of their own opinion and what is right in the situation they are all embroiled in. 

This device also helps to exemplify the theme of people's love for others and the myriad of ways that it can be shown.