Don’t read this review if you are planning on reading the book or seeing the movie - I give the game away! I haven’t seen the movie yet, starring, among others, Cameron Diaz and Alec Baldwin. Here’s how I see the book.
Sara and Brian Fitzgerald’s daughter, Kate, is dying from a form of acute promyelocytic leukemia so rare that in order to save her they bring into the world a genetically engineered daughter, Anna, who will be the perfect donor her sister needs.
This is a skillfully, cleverly written novel which I enjoyed reading. Picoult certainly got me into the story and elicited strong responses from me. Yet while her novel is strong on emotion it is actually very shallow in dealing with the ethical issues raised by the contrived scenario Picoult creates. Indeed, so contrived is the plot that Picoult extricates herself from the ethical dilemma that seemingly confronts 13-year old Anna by conveniently arranging for her death before the book’s end.
Ever since she has been born Anna has been denied the possibility of ever living a normal life, due to the need for repeated hospitalizations, involving some risky medical procedures to enable her sister to keep living. The plot revolves around Anna suing her parents for medical emancipation, following pressure placed upon her by her mother to donate one of her kidneys for her sister. By the end of the novel the ethical issues have never been properly confronted, but skirted around and one is left with the distinct impression that the now medically emancipated Anna will probably, of her own volition, donate a kidney anyway, even though, the “lightning bolt” secret comes out near the end of the book, that it was in fact Kate herself who persuaded Anna to seek medical emancipation. While Kate fears death she does not want life to continue as it has and feels that life is grossly unfair for her sister.
Picoult’s way of skillfully reeling the reader in, like a dumb fish, is by looking at the situation through the eyeballs of each of the main characters, Anna, Kate (though this perspective is deliberately left to the end of the novel), Sara, Brian, Anna’s lawyer (Campbell Alexander) and the court-appointed guardian-advisor, Julia. I suspect many readers would feel a lot of sympathy with the ethical perspective adopted by the characters. I didn’t. In my opinion Picoult’s handling of ethical issues is seriously defective.
“By examing each character’s struggle between ethics and emotion”, reviewer Megan Gray thinks Picoult has succeeded in demonstrating that “it is painfully obvious that there is no right and wrong choice, there is no final answer. What results is an extremely thoughtful, delicate, and heartbreaking story that is wrought with emotion and suspense that climaxes with a shocking ending” (my boldfacing).
Christine Scivicque believes the novel:
provides a strong argument for the idea that ethics and morals are not hard and fast rules; rather they can be incredibly adaptive depending on the circumstances, emotions and history of the person or people involved.
Indeed, Picoult’s ethics are evidently relativistic and emotivist. Given modern secularization I am not surprised that there is a complete lack of any religious reflection in this book. Picoult elsewhere has spoken of having a belief in some kind of “God”, a somewhat shapeless concept it would appear. If this book is anything to judge by, it would seem that for Picoult God is a complete irrelevancy when it comes to working out what is right or wrong in ethical situations like this. Indeed, near the end of the book she has Sara, a former lawyer, declaring after her final argument in court that she knows that what she has done is “right”, not because of any well-argued consideration of ethical principles, but simply because she FEELS her actions have been right. The staggering thing about this book is that, aside from its sidelining of God and any religious or spiritual considerations, there is not even any non-religious philosophical reflection of any substance.
The lack of a religious perspective is a major omission given that in the US, as I understand it, it is common for hospital ethics committees to include chaplains.
In making these comments I do not deny the complexity of human character. It would be wrong, for example, to think of Anna’s mother as a cold-hearted bitch with respect to Anna and her son, Jesse. However, her love and concern for Kate is so all-consuming that her relationships with Anna, Jesse and, yes, even with her husband are all very seriously damaged. Jesse has become a pyromaniac, causing a string of mystery arsons eventually uncovered by his father, the captain of the local fire station. Anna’s life has been seriously damaged by her inability to have normal relationships and engage in normal activities, for example, develop her skills and enthusiasm for ice hockey. On the home front, at least, Brian is effectively manipulated by Sara and I personally saw him as a rather pathetic figure, especially illustrated by his capitulation during the trial, when he turns back from his temporary expressions of support for Anna to side again with his wife.
Picoult treats such relational rifts as though they were fairly superficial. Jesse’s problems are easily solved and the book ends with him beginning a successful career in policing. By book’s end Sara and Brian’s marital relations have a new spark and tensions between the parents and Anna seem to be resolved. This all seems highly unrealistic.
So what about the ethical issues?
Is it wrong to have a child who is a means to an end?
Some might argue that giving birth to a child so that her umbilical cord can be used for her sister’s stem cell transplant is little different from families that have had children to help with doing hard work on the farm. As one medical ethicist pointed out, interacting with the book, royal families would often seek to have multiple children so that if the heir died another would be able to become the new heir. But all such examples show is that others too have treated children as means to an end.
It is my view that My Sister’s Keeper powerfully illustrates the veracity of Alasdair Macintyre’s hypothesis, as presented in After Virtue: “that in the actual world which we inhabit the language of morality is in [a] state of grave disorder.” All we now have are “the fragments of a conceptual scheme, parts which now lack those contexts from which their significance derived” (2). We continue to use many key moral expressions but have lost, perhaps entirely, our comprehension of morality, both theoretically and practically.
My Sister’s Keeper belongs to a world in which moral discourse is in a state of great disorder and reflects the emotivism that is the major morality of today. MacIntyre sets himself to confront this emotivism: “the doctrine that all evaluative judgments and more specifically all moral judgments are nothing but expressions of preference, expressions of attitude or feeling, insofar as they are moral or evaluative in character” (11-12).
As Macintyre observes, emotivism appears in a variety of philosophical guises and “to a large degree people now think, talk and act as if emotivism were true, no matter what their avowed theoretical standpoint may be. Emotivism has become embedded in our culture” (22).
Macintyre argues that the key to the social content of emotivism is the obliteration of any genuine distinction between manipulative and non-manipulative social relations. This is in contrast to Kantian ethics and many earlier moral philosophers for whom a human relationship uninformed by morality involves treating the other person as a means to an end, while a human relationship informed by morality involves treating the other person as an end. The latter is expressed in an unwillingness to influence the other except by reasons which that person judges to be good and impersonal criteria adjudged to be valid, while the former is concerned not with the standards of a normative rationality but with those influences or considerations that will effectively persuade the other to do what I want.
This clearly pertains to the ‘disordered’ moral discourse of My Sister’s Keeper, which via the quasi-ethical vehicle of emotivism, justifies treating Anna as a means to an end, at least within the ethically relativistic world of the book. It is patently clear in the book that Sara “is concerned not with the standards of a normative rationality but with those influences or considerations that will effectively persuade [Anna] to do what [she] want[s].”
As Macintyre points out, if evaluative utterance only serves to express my own feelings and change the feelings and attitudes of others then there are no impersonal criteria to appeal to and the distinction between manipulative and non-manipulative social relations is illusory. All moral discourse is manipulative. This is precisely the nature of the moral discourse employed by Picoult.
Post-Enlightenment morality has dislocated itself from classical morality. Classical ethics, as illustrated by Aristotle, involves a fundamental contrast between man-as-he-happens-to-be (an untutored state) and man-as-he-could-be-if-he-realised-his-essential-nature, with ethics being the science which teaches how to get from the one to the other. It is this classical approach to ethics that is also essentially the same in biblical thought, though, of course, the Christian worldview incorporates into ethical teaching that which God has revealed to be his will for human beings. Also, of crucial importance to the Christian worldview – and this is a perspective almost totally absent from My Sister’s Keeper (except in some fairy tale like fantasizing about some kind of afterlife, vaguely dubbed “heaven”, into which can be projected whatever kind of afterlife one wants) – is the understanding that the realisation of the essential nature of human beings as those created in God’s image, does not belong merely to this life, but also to the next. By contrast, My Sister’s Keeper, is a dismal hope-less book, which treats the continuance of Kate’s life in this world as the ultimate end to be achieved. Further, the ethics of My Sister’s Keeper never incorporate any notion of preparing oneself for what will happen after death.
Tragically, as Macintyre observes, Hume and Kant “discerned no essential natures and no teleological features in the objective universe available for study by physics” (54). So both, along with Diderot, Smith and Kierkegaard, “reject any teleological view of human nature, any view of man as having an essence which defines his true end” (54). As Macintyre explains, this is precisely why their project of finding a basis for morality had to fail. For this necessarily involved eliminating the notion of man-as-he-could-be-if-he-realised-its-telos, one of the essential components of classical and, indeed, of biblical morality, in which the whole point of ethics is to enable man to pass from his present state to his true end. By removing this component, as reflected in My Sister’s Keeper, moral discourse is robbed of its teleological content.
The emotivist ethics of My Sister’s Keeper are grossly deficient because they do not involve any serious consideration of what it means to be human nor of what the purpose of life might be. The parents’ moral choices, including the decision to have a genetically engineered daughter, were always deficient in this book because they never seriously factored in such considerations.
In Mark 12:28-31 we read:
One of the teachers of the law came and heard them debating. Noticing that Jesus had given them a good answer, he asked him, “Of all the commandments, which is the most important?”
“The most important one,” answered Jesus, “is this: ‘Hear, O Israel, the Lord our God, the Lord is one. Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength.’ The second is this: ‘Love your neighbor as yourself.’ There is no commandment greater than these.”
It is these two commands and their complete complementarity that forms the foundation of all Christian ethics. They presuppose what it means to be human and what the purpose of life is – first, to live a life which ends up with an all-consuming love for God and a corresponding love for others that treats them as every bit as important as oneself. Isn’t it wonderful to see how Jesus skillfully steers clear of any idea that an all-consuming love for God makes other relationships unhealthy? Of course, it is right and proper that a married couple love each other deeply and profoundly. But if a man and his wife make their love for each other all-consuming then this is a destructive, not a constructive love which will damage other relationships and profoundly hurt others. If parents have an all-consuming love for their children then this will damage other relationships and profoundly hurt others.
In My Sister’s Keeper Sara has total allegiance, a total commitment to her sick daughter, the daughter who without such a perfect donor will certainly die. It is a tragic story, not least because the mother has made an idol out of her relationship with her daughter, however much we might sympathise with the emotions that drive her to do this. This is her “god.” It is to this god that she pours out all her devotion. And in so doing she alienates not only her son but also the daughter who was brought into the world to be a donor for her sister and who is constantly taught by her mother, even if unintentionally, that this is the only value her life has.
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