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“My Sister’s Keeper”
by: Jodi Picoult
Ethics: Week 5 Presentation
November 2010
Jaelin Mayer
Stephanie Noble
Stephen Lee
Story Outline
Kate is a 16 year old who was diagnosed with Leukemia at 2
years old. She has an older brother, but he is not a genetic
ma...
Now that Kate is 16, she is progressively getting weaker
and treatments are no longer effective. Kate does not want
to be ...
Presenters
 Jaelin Mayer – Role of Anna
 Stephanie Noble – Role of Kate
 Stephen Lee – Role of Parents
Step 1: Ethical
Questions
 Should a doctor recommend a family have another child in
order to have a bone marrow match for...
Step 2:
Our First
Reactions
STEP 3: What
are the
clinically
relevant
facts?
 Both Anna and Kate are minors.
 Kate has a cancer that will kill her wi...
What facts do you
need to gather?
 What policies are already in place?
 What does the law say about a minor donating a k...
Step 4: What are the values at stake for
all the relevant parties?
 Kate
Autonomy
Respect for Persons
Time with family...
 Anna
Autonomy
Quality of Life
Responsibility
Respect for Persons
Family relationships
Parents
Family
Health
Fidelity
 Medical Community
Providing Treatment Options
Acting in the Patient’s Best Interest
Education
Empathy & Compassion
...
Step 5:
What could you
do?
 As Kate,
 I could tell my family and doctors my wishes not to
receive more medical treatment...
 As Anna,
 I could donate my kidney, even though it will alter my
future plans, there is a risk that I could die, and it...
 As the parents,
 We could talk with Kate
about how she is doing with
all the medical treatments,
discuss what she wants...
 As the Medical Community,
 We could educate the family.
 We could talk with Kate and Anna individually.
 We could sol...
Step 6:
What should you do?
 Educate
 Long-term Consequences
 Odds of Recovery
 American Academy of Pediatrics
Guideli...
Step 7:
Justify your choice
 Education
 Patient’s Best interest
 Integrity
Step 8:
How could this ethical
issue have been
prevented
 Education regarding the existing American Academy of
Pediatrics...
Resources:
 http://www.suite101.com/content/book-review-my-sisters-keeper-
a38500 (for summary of the book/movie)
 “Mino...
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My sister’s keeper - final

Team posterior - Final Ethics Presentation
Fall 2010
Jaelin Mayer
Stephanie Noble
Stephen Lee

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My sister’s keeper - final

  1. 1. “My Sister’s Keeper” by: Jodi Picoult Ethics: Week 5 Presentation November 2010 Jaelin Mayer Stephanie Noble Stephen Lee
  2. 2. Story Outline
  3. 3. Kate is a 16 year old who was diagnosed with Leukemia at 2 years old. She has an older brother, but he is not a genetic match for a bone marrow transplant. Doctors recommended that her parents scientifically engineer another child to ensure a bone marrow match for Kate. Kate’s parents eagerly pursued having another child in order to try and save Kate’s life. Anna is born and from birth is subjected to multiple procedures in order to treat Kate. From donating bone marrow to blood, Anna spent a lot of her childhood in the hospital as well.
  4. 4. Now that Kate is 16, she is progressively getting weaker and treatments are no longer effective. Kate does not want to be treated anymore. She is ready to let go but doesn’t know how to tell her family. Doctors say a kidney is Kate’s only chance for survival. Her parents are pushing Anna to donate, even though there are definite long-term consequences for Anna if she only has one kidney. Unable to convince her parents that she does not want to donate her kidney to her sister, she hires a lawyer to sue for medical emancipation.
  5. 5. Presenters  Jaelin Mayer – Role of Anna  Stephanie Noble – Role of Kate  Stephen Lee – Role of Parents
  6. 6. Step 1: Ethical Questions  Should a doctor recommend a family have another child in order to have a bone marrow match for a living child?  Should a family scientifically engineer a child for the sole purpose of harvesting tissues and organs for another child?  Do Anna's parents have the right to require Anna to donate an organ to her sister?  Is Anna, 13 years old, subject to her own assent, or is she legally bound to her parents will because of her age? Should she have any say in her participation in donating tissue/organs?  As Kate is dying, does she have the right to request the cessation of treatments when recovery seems very remote?
  7. 7. Step 2: Our First Reactions
  8. 8. STEP 3: What are the clinically relevant facts?  Both Anna and Kate are minors.  Kate has a cancer that will kill her without treatment and Anna is the only organ/tissue match for this treatment.  By continually donating, Anna’s quality of life has been greatly impacted.  The parents want to continue fighting the cancer – at all costs.
  9. 9. What facts do you need to gather?  What policies are already in place?  What does the law say about a minor donating a kidney?  What are the health risks for Anna in continually giving bone marrow and tissues?  What are the health risks for Anna to donate a kidney?  What are the chances for Kate’s survival and cancer remission if she continues to receive bone marrow and a kidney transplant?  What has been communicated to the parents regarding Kate’s chances for survival?  Is the family in any kind of support group that could help them process through these decisions?
  10. 10. Step 4: What are the values at stake for all the relevant parties?  Kate Autonomy Respect for Persons Time with family Dying with Dignity
  11. 11.  Anna Autonomy Quality of Life Responsibility Respect for Persons Family relationships
  12. 12. Parents Family Health Fidelity
  13. 13.  Medical Community Providing Treatment Options Acting in the Patient’s Best Interest Education Empathy & Compassion Respecting decisions of patient/family
  14. 14. Step 5: What could you do?  As Kate,  I could tell my family and doctors my wishes not to receive more medical treatment.  I could let Anna give me her kidney and be thankful for the small amount of time it would buy me with my family.  I could sue for medical emancipation for myself so I could choose when to stop treatment.  I could refuse the treatment and hope people would support my decision.
  15. 15.  As Anna,  I could donate my kidney, even though it will alter my future plans, there is a risk that I could die, and it may not ultimately save my sister’s life.  I could sue my parents for medical emancipation so that I can make the decision about my kidney and any future procedures for myself, although this will anger my parents and my sister may die as a result.
  16. 16.  As the parents,  We could talk with Kate about how she is doing with all the medical treatments, discuss what she wants to do, and try to come to a decision on the future steps of her care based on the conversation.  We could let Kate die with dignity.  We could wait for another treatment option.  We could force Anna to donate her kidney.
  17. 17.  As the Medical Community,  We could educate the family.  We could talk with Kate and Anna individually.  We could solely follow the AAP criteria for a minor donating an organ.  We could refuse to perform a transplant on a minor.  We could do the transplant based on the parents’ wishes.
  18. 18. Step 6: What should you do?  Educate  Long-term Consequences  Odds of Recovery  American Academy of Pediatrics Guidelines Donor Advocacy Team Minor Consent
  19. 19. Step 7: Justify your choice  Education  Patient’s Best interest  Integrity
  20. 20. Step 8: How could this ethical issue have been prevented  Education regarding the existing American Academy of Pediatrics Guidelines.  Establish a policy regarding scientifically engineering a child for a bone marrow match.
  21. 21. Resources:  http://www.suite101.com/content/book-review-my-sisters-keeper- a38500 (for summary of the book/movie)  “Minors as Living Solid-Organ Donors” By Lainie Friedman Ross, MD, PhD - http://pediatrics.aappublications.org/cgi/content/full/122/2/454  “Health Care Decisionmaking by Children. Is it in their best interest?”, by Lainie Friedman Ross  http://stemcells.nih.gov/info/ethics.asp  Should minors be able to serve as living organ donors – “www.vcu.edu/.../should%20%minors%20be%20living%20donors_.ppt  All pictures are taken from movie clips

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