This post is not a review and contains no spoilers. It does touch on the abortion issue, for which I ask that commenters tread lightly with respect towards people with differing views.

Last week I listened to the audiobook for Jodi Picoult’s My Sister’s Keeper. Clancy read and highly recommended the book and the plot actually tied into a hypothetical I was thinking may put into a creative project some day. So I took a break from Tom Clancy and detoured to Picoult. Though there’s something about Picoult’s writing I find a little offputting – I can’t put my finger on exactly what – the book itself was excellent, with the plot outstripping any of Picoult’s expressive peculiarities.

The story revolves primarily around the Fitzgerald family and two sisters within it. Older sister Kate was diagnosed with leukemia when she was three or so. Her parents, Brian and Sara, then had another daughter, Anna, by way of science so that they would have a donor to save Kate’s life. It was initially successful, but over time more and more became required of Anna to keep her sister alive. The novel starts with her at age 13 (Kate is 16) with her parents gearing up to volunteer her kidney for a transplant to Kate. For Anna, who has given blood, bone marrow, and more for her entire life, this is the last straw. She hires a lawyer so that she can be medically emancipated and make her own medical decisions.

The novel is more of a problematic than anything. By and large, none of the characters are completely good and none are evil. Most, with the exception of the sisters’ brother Jessy, are decent people. But the story involves complicated decisions. I came to my conclusion as to what should happen pretty early on. As the story progressed, though, my mind moved on to a more fundamental question: how do you determine the tradeoff between the quality of life of the many versus protecting the life of someone that has been dying almost since they were born. Is it better for there to be four satisfying lives or five dissatisfying ones?

The Fitzgeralds, including Anna, love Kate. There are bouts of resentment from her siblings from time to time, but it’s not like Kate chose her fate nor are the actions of her parents anything less than completely understandable and by and large Jessy and Anna realize this. Brian and Sara, the parents, love their daughter immensely, but there’s no denying the toll that a daughter always one relapse away from death has taken from their lives. Brian comments to one of his fellow firefighters that he stays at work late because, if he didn’t, he would have to go home. The lack of attention that Jessy got helps lead him down a wayward path where misbehavior is the only way he gets attention. And Anna is not allowed so much as to attend hockey camp. Not because of financial reasons, but because something could go wrong with Kate and she would need to stand by with parts to donate to the cause.

It’s hard to look at this situation and not wonder, at least a little bit, how much happier this family might be if Kate had simply rejected the initial transplant and died when she was three. Jessy might have gotten the attention he needed. Anna would have been able to live her own life. Brian and Sara would have been more husband and wife and less disaster management partners, which is what they became. Of course, it would be a raw deal for Kate. She would be dead. It’s tempting to dismiss this as a question of whether her life, lived in constant acceptance of the inevitability of coming death, is worth living. But when it’s your life, it’s different than merely speculating from afar. Studies have demonstrated that being crippled, for example, ultimately does not have much bearing on levels of happiness.

My friend Rick is staunchly pro-life when it comes to abortion and euthanasia. That I even ask these questions would render me, in his view, a card-carrying member of the Culture of Death. On the other hand, during the Terri Schiavo debate there really seemed to be a number of people that believe that the plug should be pulled not out of a sense of autonomy, but because they had simply decided that her life was not worth living. Even if there were a health care family and even if Terri and Michael Schiavo had been divorced, their view would have been the same. Though I came down on the side of the plug being pulled, it was on a somewhat different basis. If it weren’t for the fact that she was legally married to the man who legally decides what she wants, and if it weren’t for the fact that such care costs an already expensive health care system even more money, I would be perfectly content for her to live her life as a vegetable. But given the givens, and given her state at the time, I believe that the right conclusion was reached.

Easy for me to say, I know. And I had to remind myself of this over and over again when it came to Kate Fitzgerald. I had to fight off the belief that “Look, she had 13 more years of life than anyone ever expected. It’s time for everyone to move on.” Easy for me because I am not Kate and I do not love Kate. The fighting off of that belief was not, however, fully successful. While the Kate/Anna situation may be uniquely derived for the sake of an engaging novel, it’s something that we’re confronted with on an institutional level every day. How much do we spend to extend an old person’s life for a few months? Every dime spent there is a dime that could be spent on someone whose death is not imminent. Even for those of us opposed to abortion, what kind of exceptions (if any) should be made with conditions either incompatible with life or, if not that, incompatible with what we would consider a worthwhile life? While the Fitzgeralds’ oldest daughter’s condition lead to an additional family member, most of the time it’s going to be the other way. A family bankrupted by the health complications of a first child can’t afford to have another (and even if they aren’t bankrupted, the time and devotion required alone could preclude it).

As someone of (relatively) sound mind and body, these remain easy thoughts for me to think. And on a personal level, this is particularly true since I owe my life to a miscarriage my mother had. Yet knowing my innate biases does not seem to prevent me from forming my beliefs based on them. It is enough, though, for me to see this as an immeasurably complicated issue. And one that, when some procedure can extend my life by a “mere” six months, is definitely subject to change.