Bioethical Issues in My Sister’s Keeper: Having Your Autonomy Taken to Save Your Sibling

Every day nurses and doctors are faced with ethical issues that can affect the patient’s quality of life. It is important for the health care provider to consider all the factors and what the patient wants for their plan of care. My Sister’s Keeper was a drama film released in 2009, which touched numerous amounts of ethical issues that caused a dilemma between the family and their kids. It is important as a health care provider to make sure the patient keeps their autonomy while informing them about what the best options are even if it is against what they want. The purpose of this paper is to discuss how autonomy, beneficence, non-maleficence, and justice are essential in providing the best patient care while making hard decisions, and to compare the movies ethical issues to the issues going on in nursing today.

Summary

In the film, My Sisters Keeper, Sara and Brian Fitzgerald who were the parents of Kate met with her doctors to explore other options to help their daughter Kate live a longer life. Kate was a young girl who was diagnosed with leukemia and went through various procedures to extend her life. Over time she did not seem to be getting any better. The doctor suggests they have a child through in vitro fertilization so she can be a compatible organ donor to Kate. The family went through with it and Anna was born in hopes to save her sister. Throughout the years, Anna went through many medical procedures with no consent. As she became older, Anna realized she did not want to go through medical procedures anymore because it was her body. She then decides she wants to sue her parents for medical emancipation so she can make her own decisions about her body. Anna gets a lawyer who helps her through the process. Throughout the trial, Kate was at the hospital getting worse by the day. Before the trial was over, everyone found out the reason why Anna decided to get emancipated. Kate had encouraged Anna to go through with the process due to the fact that she was tired of all the surgeries and the pain. She wanted to end it and the only way to do that was to not go through with the kidney transplant. Kate eventually died before the decision was made. Eventually, Anna became medically emancipated after Kate’s death.

Ethical Issues in the Film

Several bioethical issues are surfaced throughout the whole film. Designer babies are babies who are scientifically engineered in vitro for specific traits in order to prevent or fix diseases. Designer babies can be used for different reasons like preventing certain genes in a baby for example cystic fibrosis. This can eventually lead to using designer babies for unethical reasons such as picking out the eye color or deciding the gender of the baby. In My Sisters Keeper Anna’s parents abused the process of in vitro fertilization by conceiving a child whose sole purpose was to be a donor. Anna was only born so she can help save her sister by undergoing procedures like bone marrow transplants and organ transplants. Anna’s parents did not seem to value risking the life of Anna as long as it saved Kate. In the movie, her parents were never concerned about the risk and damage it would do to Anna. During the trial, Anna’s lawyer made a point how Anna was never consulted before each procedure. Anna’s family always put Kate first while ignoring Anna’s health and Jesses, who was Anna’s older brother, personal issues. In the film, there were other obvious ethical issues such as, is a child capable of making their own medical issues? Sara believed Anna was “too young” to understand what was going on nonetheless make her own decisions. She refused to let Anna decide what procedures she can refuse. Another issue that came alone was when will it ever be enough to stop using a child for the sole purpose of saving a life? Is it ethical to have a child just to save another? Sara and Brian did not seem to have an issue with having Anna for one purpose only. In this film, Anna was never once asked how she felt about undergoing different procedures. Many of these ethical issues still occur in nursing today and are important to address them to make a decision about the plan of care. Chronic medical conditions in childhood have implications for the psychosocial well-being of children and their families. This is why it is important to communicate with the patient about their feelings because it can affect different aspects of their well-being.

Autonomy

In nursing, it is important to promote a patient’s right to autonomy. Autonomy is allowing the patients to make their own decision even if it is denying treatment. Although some physicians may not agree with the decisions, they still have to respect it. Patients have the right to determine what they think is best for them and how they chose to go about their decisions when it comes to their health. In the film My Sisters Keeper, Anna did not have any autonomy her whole life. She was constantly going through medical procedures like blood transfusions to try to keep her sister alive and prolong her life. Anna was never given a choice when it came to her body. She never had the opportunity to refuse any procedures or was ever consulted about how she felt. Anna’s parents were too busy with Kate’s illness to even bother to think how these procedures would affect Anna’s life. Anna never gave consent to any of these procedures leading her to eventually get tired of it and refusing the kidney transplant. Eventually, she got tired of the constant decisions being made for her and not having a say in what goes on with her body that she sued her parents for medical emancipation. Anna’s mom told her she was just a child and she had no idea what she was doing. “A child’s capacity to consent must be assessed on a case-by-case basis and will depend on the complexity of the proposed treatment and the child’s stage of intellectual development” (Taylor 2014). This is exactly what happened in Anna’s case. She went through trial where she was evaluated to see if she was competent to make her own decisions. In the end, she was granted her wish to be medically emancipated.

Beneficence

Beneficence was an ethical principle also shown in this film. Beneficence is an act done for the benefit of others. In this case, beneficence was shown the moment Sara and Brian agreed to conceive a child only to save their daughter Kate. In the eyes of Sara and Brian, it seemed to be their best option. It prolonged the life of Kate and bought her more time with them. They did not see the risks and pain Anna would be going through. Their judgment was clouded by Kate’s situation that nothing else seemed to matter. Anna’s birth would benefit Kate from the day she was born. Anna’s parents saw no harm in doing this and were not hesitant about doing so. These procedures were never good for Anna’s health, but it benefited Kate’s life.

Non-maleficence

Non-maleficence is the act of doing no harm. In the film My Sisters Keeper, non-maleficence was not shown. Everyone was so concerned for Kate and her health that no one seemed to care or ask Anna how she felt about undergoing procedures as she grew up. Her parents automatically assumed that because she was her sister, she was going to agree to it regardless. Sara’s actions were the opposite of what the principle non-maleficence means. She was putting Anna through unnecessary pain only to save her older daughter. Throughout the whole movie, Anna was harmed for the sake of her sister. Many of these problems could have been avoided if the birth of Anna would have been thought out more clearly. Kate’s agreement to go through in vitro fertilization just by considering the health of Kate was wrong. Many more factors should have been considered but her decision was very impulsive. “Decision-making about transplantation, donation and the creation of a ‘savior sibling’ for a sick child cannot be made by a clinician alone and cannot be based simply on a considered analysis of risk-benefit equations either by the clinician or the parent” . One can see why Sara and Brian chose to have a “savior baby” but it was obvious hey did not care to think enough about how these procedures would do harm to Anna in the future. Saunders (2017) believed that parents should consider the wellbeing of the child as well as how the child will affect others. One can slightly agree with that statement but in this case, no one seems to worry too much about the possible harm any of these procedures would do to Anna or her health.

Justice

Justice is the action of treating people fairly. Towards the end of the film, Anna receives justice after putting up a fight against her mother Sara. Anna had to go through various trials before any decision can be made. Anna realized that she was going against her mother’s wishes and knew she was going to create problems within her family members and she still went through with it. Anna was seen more as “savior baby” constantly going through medical procedures to try to save her sister. In the long run, no one cared about the damage she went through or any of the traumatic experiences she felt as a young girl. It is obvious that toddlers are afraid of needles one can only imagine how Anna felt as a young girl. It was later known that Kate also did not want to go through any more surgeries and was ready to die in peace. It was only fair to allow Anna to keep her organs while respecting Kate’s decision.

Current Ethical Issues

There are several ethical issues going on in the field of nursing. Informed consent is an important process that a patient must do before any procedure can take place. It is an agreement between the surgeon and the patient. Once the patient understands the procedure and the risk, he or she can sign off to it. A nurse must ensure the patient keeps their autonomy. A surgeon must promote beneficence while still allowing the patient to be autonomous. There can be a dilemma when the patient refuses treatment even though the doctor knows this helps the patient get better. A nurses’ job during informed consent is to maintain autonomy and understanding. In the film, My Sisters Keeper, Anna was never asked how she felt about a procedure. She never “gave consent” when she was younger which was reasonable because she did not fully understand much yet. Until she got older is when she began to understand everything that was going on with her. She became fed up and thought to herself when will it ever be about her and her feelings. She eventually denied undergoing an organ transplant. The question here is, just because she’s a child does it give them the right to take away her autonomy? These are issues that go on in nursing now where some people are not able to give consent even though they are fully aware of the risks and benefits.

Conclusion

In conclusion, this film portrayed many ethical issues that occur today in nursing. It is important to see everyone’s point of view but most importantly the patients. In the field of nursing, it is important to make sure the patient has autonomy. It is only right to respect the patient’s decision even if it is against what one may believe is best. The ethical principles discussed in this paper played an important role in the process of making decisions with Anna. The trial Anna went through in order to get medically emancipated brought up many valid points whether it is okay to force a child to undergo procedures to save the other. These ethical principles play a big role when making decisions in nursing today. The impact of the ethical issues portrayed in the film raises big questions in nursing today. Issues like whether or not a child can choose what goes on with their body or whether it is okay to conceive a child only in hopes to save another should be evaluated on a case to case basis. If one is fully aware of what is going on and is capable of making their own decisions, there should be a way to allow them to make a decision or have an input at the very least. It is very crucial for a nurse to advocate for their patient when the patient may be afraid to say anything.

References

1. Doron, H., Hen, M., & Sharabi-Nov, A. (2018). Relationship Quality among Chronically Ill Children and their Parents. Journal of Child & Family Studies, 27(12), 3866–3876. https://doi-org.ezproxylocal.library.nova.edu/10.1007/s10826-018-1228-8
2. Furst, S., Golman, S., Johnson, M., Pacheco, C., Trooper, M. (Procedures) & Cassavetes, N. (Director). (2009). My sister’s keeper [Motion picture]. United States, Curmudgeon Films: Studio
3. Saunders, B. (2017). First, do no harm: Generalized procreative non-maleficence. Bioethics, 31(7), 552–558. https://doi-org.ezproxylocal.library.nova.edu/10.1111/bioe.12366
4. Strong, K., Kerridge, I., & Little, M. (2014). Savior Siblings, Parenting and the Moral Valorization of children. Bioethics, 28(4), 187-193. https://doi-org.ezproxylocal.library.nova.edu/10.1111/j.1467-8519.2012.02001.x
5. Taylor, H. (2014). Promoting a patient’s right to autonomy: implications for primary healthcare practitioners. Part 1. Primary Health Care, 24(2), 36-41. Retrieved from http://search.ebscohost.com.ezproxylocal.library.nova.edu/login.aspx?direct=true&db=ccm&AN=104034270&site=ehost-live