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Book Review

This book has been reviewed by Focus on the Family’s marriage and parenting magazine.

Positive Elements

Spiritual Content

Sexual Content

Violent Content

Crude or Profane Language

Drug and Alcohol Content

Other Negative Elements


Pro-social Content

Objectionable Content

Summary Advisory

Plot Summary

Told from multiple perspectives, My Sister's Keeper follows the story of 13-year-old Anna Fitzgerald as she sues her parents, Brian and Sara, for medical emancipation.

Anna was conceived as an allogeneic donor for her sister, Kate, who suffers from acute promyelocytic leukemia (APL). Since birth, Anna has donated stem cells, bone marrow and platelets to keep Kate alive. Now Kate is entering the end stages of kidney failure. Receiving one of Anna's kidneys is her only chance of a prolonged life, but Anna refuses to donate. Knowing her parents won't listen to her protests, Anna approaches Campbell Alexander, a prominent lawyer with a service dog named Judge. Campbell agrees to work pro bono because of the publicity the case will generate. However, Anna's determination wavers under intense pressure from her angry mother, who also happens to be a lawyer. So Judge DeSalvo assigns Julia Romano to be Anna's guardian ad litem. Julia is Campbell's high school sweetheart. Neither have a serious relationship with anyone else, but they have not spoken to each other in 15 years.

An eventful week precedes the hearing. Campbell and Julia navigate the stormy waters of their once passionate relationship. Jesse, the oldest of the three Fitzgerald children, continues to distill and consume homemade moonshine, take drugs, smoke cigarettes and light fires in abandoned buildings. His firefighter father gets a rude wake-up call when he realizes that his son is the arsonist responsible for many recent blazes. As Sara prepares for the upcoming hearing, she's torn between caring for Kate, who is dying, and meeting the needs of her spouse and other two children. Anna grapples with the consequences of her actions, unsure of whom she will be without Kate in her life.

Campbell is an epileptic and suffers a grand mal seizure in the courtroom, which is described in detail. After taking a brief recess to compose himself, Campbell asks Anna to testify. Battling an extreme case of nerves, Anna reveals that she was always willing to donate her kidney. Kate was the impetus behind the lawsuit. After several failed suicide attempts, she asked Anna to kill her. Judge DeSalvo verifies the facts with Kate. He will make a final decision the next day.

It's raining on decision day, and visibility is poor as the various parties make their way to the courthouse. Everyone agrees on one thing: The lawsuit isn't about a kidney. It's about Anna's right to decide what happens to her body. Judge DeSalvo grants Anna's request for medical emancipation, and Campbell assumes power of attorney for all of Anna's medical decisions until her 18th birthday. Campbell and Anna leave in the lawyer's car to complete the necessary paperwork.

Brian is on duty when he is called to the scene of an accident involving a truck and a small BMW. He threads his way through the wreckage. Too late, he realizes the small figure in the front seat is Anna. She's dead. Campbell is injured but alive. He gives permission for Anna's organs to be harvested, and Kate receives Anna's kidney.

Eight years later, Kate is a dance instructor. Her doctor is baffled by her recovery. Jesse becomes a police officer. Campbell and Julia get married. Despite their continued grief, the Fitzgeralds move on with their lives, feeling that Anna is still with them because of all of her contributions to Kate's life and health.

Christian Beliefs

The book's title, My Sister's Keeper, is a reference to Genesis 4:9. When Julia requests information about Anna's whereabouts, Jesse asks if he is his sister's keeper. A cancer patient wears a shirt sporting the words: Jesus saves. Chemo scores. The story of Adam and Eve is referred to as a load of crap. Accusing Sara of playing the martyr, Sara's sister asks if she wants to take her crown of thorns out of her suitcase. Anna wonders what age she will be in heaven. Campbell sues the Diocese of Providence on behalf of a child who is denied controversial treatment on religious grounds. Anna misunderstands a newspaper headline and thinks he sued God. Julia's parents are Catholic.

Other Belief Systems

Anna believes that if her parents didn't conceive her for Kate's benefit, she would still be in heaven waiting for a body. She tells her class that her dad is going to heaven because he would put out all the fires in hell. Confused by her parents' differing explanations, Anna thinks stars are the nightlights angels use to find their way to the washroom after God's bad food gives them gas.

Brian is an amateur astronomer. He tells his children the Greek myths associated with the constellations. Different astrological signs are mentioned, as is a Pawnee Indian creation myth.

A teenage Campbell speculates that the Virgin Mary had sex with Joseph and made up the story about the Annunciation to get herself out of trouble. Campbell's secretary has an aunt who is a psychic. Sara and Brian get a reading done by a psychic at a gas station. Sara talks about a previous life. Karma is mentioned. Pregnant women are compared to Buddhas.

Authority Roles

The Fitzgeralds' life revolves around Kate. Brian and Sara deeply care for each other and their three children, but Kate's illness places all of the family members under extreme stress. In particular, Sara has difficulty sympathizing with her two healthy children, as she feels their problems pale in comparison to Kate's. Jesse suffers most visibly, but even peacekeeper Anna likes to imagine that she has a real family somewhere else. Brian and Sara disagree about how to handle Anna's lawsuit. Although she is angry at her daughter, Sara makes it clear that she still loves her.

Campbell's interest in the case is at first purely selfish. He slowly grows to care for Anna, as does Julia. When Brian learns that Jesse is the arsonist, he decides not to inform the authorities. Instead, he holds the repentant Jesse and vows to stop his son's pyromania.


Profanity is used frequently throughout the book. H--- occurs dozens of times. The f-word is also used extensively. The names of Jesus and God are taken in vain often, sometimes coupled with d--n, which is used independently, too. Other objectionable words include a--, a--hole, s---, bulls---, b--ch, b--tard, d--k, and p---. Most are used more than once. Coarse words referring to the female anatomy are also used. Jesse gives the finger to irate drivers.

Brian is a firefighter. His team responds to emergencies that sometimes involve graphic scenes. His colleagues joke about an obese man who is stuck in a chimney, implying that he is a suicide arsonist. Recipes for homemade explosives are included in some of the chapters written from Brian's perspective.

Kate's illness affects her family in a number of graphic ways. She vomits blood and hemorrhages from her eyes, nose and rectum. Both Kate and Anna undergo painful medical procedures. She has a catheter in her chest, and her torso is permanently scarred in many places.

Angry at his mother for breaking a promise, Jesse removes his braces with a fork. His mouth bleeds. A teenage Campbell fantasizes about ways he can murder his parents.


Explicit sexual scenes encompass past and present encounters between Campbell and Julia, including the day Julia loses her virginity in high school. These are detailed sequences revealing the thoughts and physical responses of both partners.

A teenage Julia insinuates that her wealthy schoolmates perform oral sex on their hairdressers. Her schoolmates speculate that Campbell spends time with Julia because she is promiscuous. They fill her locker with condoms as a prank. After renewing her acquaintance with Campbell, Julia expresses the desire to make out in a dark theatre with a man who doesn't know anything about her. Julia has a sexual encounter in a car after Campbell drops her off.

Julia tells Seven, a straight bartender at a gay bar, the details about one of her lovers' genitalia. Campbell's father, a federal judge, regularly cheats on his wife with younger women and is attracted to schoolgirls.

Brian kisses Sara on the forehead. He and Sara make love. He bites her lip so hard it bleeds, then licks off the blood. Kate watches soap operas and speculates that one of the male stars might be gay. She kisses and holds hands with Taylor, a teenage boy who suffers from leukemia. Jesse is aroused by Julia and tries to get her to go on a date with him, even though she is almost twice his age. He watches a scrambled Playboy channel. Anna goes to a movie theater with a boy and notices he has an erection.

Due to the circumstances surrounding her birth, Anna is familiar with the mechanics of conception. Jesse also tells her about sex, but at first she thinks he is misinformed. She is proud that she was born for a specific purpose, not because her parents got drunk, had a failing marriage or didn't use contraceptives effectively.

Sara's labor is described in detail. When Anna first approaches Campbell, he assumes she wants access to birth control or an abortion and offers to give her the contact information for Planned Parenthood. She explains that free condoms won't fix her problem.

Julia realizes she is at a gay bar when the men sitting next to her begin kissing. Men flirt and dance with one another. Julia's sister is a lesbian and offers to hook Julia up with one of her female friends. A female security officer is compared to Hitler in drag with a bad perm. A secretary is described as having a bra size higher than her IQ.

Discussion Topics

Additional Comments/Notes

Euthanasia/Suicide: Jesse considers committing suicide in such a way that his organs could be harvested and used to help others. He also goes outside during storms, hoping to get hit by lightning. Kate tries to commit suicide, but fails. She asks Anna to help her die.

Drugs/Alcohol/Smoking: Jesse uses a plethora of illegal drugs to get high. Characters drink alcohol, often excessively, to escape reality. Some are underage. Anna tries Jesse's cigarettes, but doesn't like them. Jesse feigns drunkenness to create a diversion so Anna can sneak into the hospital to see Kate.

Underage misbehavior: Jesse steals hood ornaments from expensive cars, steals entire vehicles and drives recklessly. He shoplifts and has perpetuated an anthrax hoax.

Lying: Anna lies to a pawnshop owner about a necklace she is selling and hides the transaction from her parents. Jesse lies to Brian about quitting smoking. Campbell lies about why he has a service dog.

Movie tie-in: Producers often use a book as a springboard for a movie idea or to earn a specific rating. Because of this, a movie may differ from the novel. To better understand how this book and movie differ, compare the book review with PluggedIn's movie review for My Sister's Keeper.

Book reviews cover the content, themes and world-views of fiction books, not their literary merit, and equip parents to decide whether a book is appropriate for their children. A book's inclusion does not constitute an endorsement by Focus on the Family.

You can request a review of a title you can't find at reviewrequests@family.org.

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