Sara Fitzgerald was once a successful attorney.
That was before her daughter's cancer.
For fourteen years, Sara's life has revolved around meeting daughter Kate's every need in her battle against a rare form of leukemia. Now Sara juggles doctor's appointments, chemotherapy and surgeries with the decisiveness of a drill sergeant. She also keeps the Fitzgerald household upbeat and on task whenever a relapse threatens to destroy their vigilantly constructed world.
Taking care of a gravely ill child is a full-time occupation, says her husband, Brian. And in the case of the Fitzgerald family, it has also prompted them to pursue a decidedly unorthodox treatment protocol: Having a designer baby.
Since no relative was an acceptable bone marrow donor for Kate, Sara and Brian took the drastic measure of genetically engineering the perfect donor. The result? Anna.
Anna says she was made in a petri dish to be spare parts for her sister. And judging from Sara's treatment of her, at times it seems as if that callous assessment is exactly right. When Kate's kidneys shut down, Anna is the only one who can save her. And Mom automatically assumes Anna will cheerfully yield an organ to save her big sis one more time.
But Anna has a different idea: filing a "medical emancipation" lawsuit against her parents so that she has the final say over what does and does not happen to her body.
And she does not want to give Kate her kidney.
Much of the film pivots on the knife-edge fulcrum of an exceedingly thorny ethical question: whether Sara has the right to compel Anna to donate a kidney to save Kate. Both characters express some sound reasoning for their respective points of view. For Sara, nothing matters more than keeping Kate alive. For Anna, however, the reality is that Kate's needs will never cease. And no matter what Anna provides for her sick sister, Kate is likely to die anyway.
Ultimately, though, the film isn't really about Anna's ethics or her mother's. Instead, Anna's refusal to surrender a kidney symbolizes the process of relinquishment. Anna understands before her mother does that Kate is going to die. For Sara, however, not pursuing every possible avenue for Kate's healing is tantamount to giving up. Even as Mom defiantly refuses to accept her daughter's impending death, Anna and the rest of the family have begun to come to terms with the idea of life without their beloved Kate.
Though she suffers from periodic depression because of her trials, Kate is generally upbeat. She faces cancer with courage, working through her grief more effectively than her mom, who is stubbornly stuck in denial. Kate also recognizes how great the emotional expense of her illness has been for her family. She laments the fact that she has inadvertently consumed most of her parents' attention and caused them to be so distracted that Anna and older brother Jesse have fallen through the cracks in significant ways.
Despite these enormous tensions, though, the Fitzgeralds focus on keeping family life alive. They eat dinner together and joke around the table. They enjoy afternoons playing in their back yard. And, as a family, they celebrate Kate's life. Sara's sister, Aunt Kelly, lives with the Fitzgeralds as well and is another important link in Kate's caregiving chain.
Kate's ordeal strains her parents' marriage to the brink of divorce, but Sara and Brian work to overcome their differences and keep the clan together. When Kate goes through chemotherapy, Sara makes a bold statement of solidarity by shaving her head to resemble her daughter's baldness. Long-suffering Brian continually forgives his wife's emotional outbursts as she struggles to help their daughter. And despite her lawsuit, Anna would do virtually anything (else) for her sister.
Taylor, a young leukemia patient whom Kate meets in the hospital, becomes her boyfriend. He lovingly supports her as she goes through chemotherapy (holding a plastic tub for her as she vomits, for example). Sara says his presence is probably better than any medicine. Together, Kate and Taylor help each other look death in the eye with humor and grace.
Two other characters in the legal part of the drama, a lawyer named Campbell Alexander and the judge who hears the case, Joan De Salvo, exhibit compassion for the Fitzgerald family. Likewise, Kate's doctor is a kind, gracious and sensitive man.
[Spoiler Warning] Eventually, we learn that Anna's lawsuit wasn't really her idea. Instead, Kate put her up to it in an effort to force their mother to deal with reality. Just before her passing, Kate gives her mother a beautiful book she's worked on that artfully chronicles every chapter of her life.
When talking about how people come to be, Anna says there are "souls flying around looking for bodies" to inhabit on earth. As Kate approaches death, she says she's not sure where she'll go, but she thinks it will all be OK. Kate repeatedly compares her idea of the afterlife to the wide-open skies of Montana and suggests that she'll be reunited one day with those she loves. Accordingly, Anna calls Kate "a little piece of blue sky" after her passing.
Kate creates a piece of art that depicts her mother as an ever-vigilant guardian angel. Family members describe Kate as a miracle. Well-meaning distant relatives suggest that positive thinking could lead to a miraculous recovery for Kate, though the film depicts their faith in that unrealistic outcome as naive.
"Amazing Grace" plays at Kate's funeral. Song lyrics mention heaven. Campbell Alexander is said to have sued God and won. A joke involves zodiac signs.
In a move that deviates disappointingly from Jodi Piccoult's novel, the film sexualizes Kate and Taylor's relationship. They kiss passionately, exchange sex-oriented jokes and eventually lie down together, apparently naked, on a hospital bed. In that scene, Kate's bare back is visible as she embraces Taylor. We don't see the teens have sex, but Kate—perhaps to irritate her mother—announces later, "We did it!" Sara explodes, and Kate subsequently edits her confession, saying that they didn't do "it," but that they "did some stuff."
Brian is shown shirtless in bed talking with Sara, who wears a tank top and modest pajamas. They kiss several times. While Jesse waits for a bus, his eyes follow buxom, scantily clad prostitutes on Sunset Strip. Aunt Kelly has a penchant for tight, cleavage-baring shirts and revealing short shorts. Kate wears one outfit that shows a lot of midriff.
Kate forcefully vomits blood. Her nose also bleeds profusely in several scenes. As death nears, bruises cover her body and face. Doctors use an intimidating needle to perform a bone marrow aspiration on Anna, who has to be restrained by several nurses before the procedure. When Anna refuses to donate a kidney, Sara slaps her face. Sara also hits Brian in an attempt to stop him from taking Kate to the beach. A man suffers an epileptic seizure.
Crude or Profane Language
One f-word, about five s-words. We also hear 10 or so misuses of God’s name, including two pairings with "d‑‑n." Jesus’ name is abused three times. "H‑‑‑," "d‑‑n" and "b‑‑ch" are each uttered two or three times.
Drug and Alcohol Content
Kate holds her own macabre "going away" party in her bedroom, drinking alcohol, gobbling a bunch of prescription meds and smashing furniture. Sara and Brian drink wine and beer. Taylor jokes about how he's in the hospital for the free cocktails. We hear that the judge's 12-year-old daughter was killed by a drunk driver.
Other Negative Elements
Anna claims most babies are the product of drunkenness and no birth control. She says that only people who cannot conceive children easily actually plan for them.
Before Anna's conception, a doctor suggests to Brian and Sara—off the record—that they might consider having a genetically engineered child for the purpose of harvesting organs and blood. The same doctor later lies about Kate's temporary hospital discharge in order to avoid entanglements with the insurance company.
A grouchy nurse demands that Kate produce a urine sample. As a joke, Kate pours apple juice into the container, pretends it's urine and drinks it when the nurse returns, laughing and then spitting it at the woman.
Often unsupervised, Jesse stands on the ledge of a tall building and wanders alone through potentially dangerous neighborhoods at night. No one notices when he is late for curfew after missing his bus.
In a time in which many people go the movies primarily to escape their own lives, this is a film that offers no such solace. What it does offer is a profound portrayal of life as it often is in the real world: brutal and arbitrary. Along the way, however, a young girl's harsh fate is powerfully, paradoxically contrasted with the fierce, unfailing love of her mother and her family.
There is a quiet strength in a film like this one, a film that unflinchingly focuses on a tragedy without succumbing to the feel-good Hollywood formula that demands a happy, sappy ending. And there is a certain wonder in characters coming to peace with horrible things they don't want and cannot understand. Kate does this before she dies, and her family gradually does the same after her death.
Though the film's spiritual themes are merely peripheral—and God's salvation message is never presented as a means to understanding or coming to terms with death—they nonetheless prompted me to ponder the fact that God owes us no answers for the incomprehensible and painful events He sometimes allows in our lives. There is mystery in His decisions, mystery we must accept. Some of us live and some of us die, as Anna says, and we may never have any idea why.
Acceptance is one response to such imponderables, a destination Kate reaches before her passing. Denial, the road Sara walks, is another. When we, like Sara, desperately cling to the way we think life ought to be, we can become so myopically focused on its disappointments that we miss the bigger picture. Indeed, up until the very end, Sara is so intent upon saving Kate that she's rarely (if ever) actually present in the moment with her daughter. The possibility of joy and grace amid the pain gets squelched by Sara's ironclad determination to maintain control—not to mention her desperate decision to create and manipulate life for her own purposes.
Despite those very real flaws, however, Sara is a deeply compelling character in her own right, a mother whose love for her dying daughter is indomitable. And who are we to say we wouldn't react similarly in her shoes? Sometimes, though, a child does die. The world is at times indescribably painful. And in a culture obsessed with knowledge and control, the inevitability of loss and death is a hard thing to come to grips with.
Movies like My Sister's Keeper model what it might look like to grapple with such heartrending losses with dignity and grace. Even when the answers remain elusive, there comes a point when, perhaps after fighting fiercely, we, like Sara, finally relax our grip and open our hearts to a path different than the one we'd once mapped out.
Still, once you put all the physical, psychological and spiritual pieces into place, you should be left pondering the validity of whether anyone should be encouraged to seek out and grasp peace about dying—without any concern for what's on the other side.