My Sister's Keeper tells the story of 13-year-old Anna Fitzgerald who sues her parents for medical emancipation. They expect her to give up one of her kidneys for her older sister Kate, who has had leukemia since she was 2 years old. Her parents conceived Anna because they needed a donor of umbilical chord blood to keep Kate alive, and since then Anna has donated bone marrow and stem cells to Kate when she relapsed. But now she no longer wants to continue being used as an organ bank for her sister, and her only resort is the law. She does her research and then goes to a lawyer, Campbell Alexander, who has had some notable successes representing children in courts. Alexander goes around with a service dog, but he is not blind, deaf, or physically disabled, and he won't tell anyone what the dog is for. When Anna asks why he has the dog, called Judge, he wisecracks that he has an iron lung and the dog keeps him away from magnets.

The novel takes the reader through the lawsuit, told from the points of view of each of the major characters, Anna, Kate, their brother Jessie, their parents Sarah and Brian, Campbell, and Anna's guardian ad litem, Julia, who turns out to have been Campbell's college girlfriend. On the audiobook, each character's portions is narrated by a different performer, which enhances the sense that these are genuinely different perspectives. The reader comes to understand the quandaries faced by Anna's parents, who love all their children but are forced to make impossible decisions by Kate's illness.

Picoult's writing keeps the story moving along fast, and her style is smooth, almost slick. Each chapter starts out with a portentous quotation from a famous writer, and she crams the book full with flashbacks to emotionally powerful moments from the narrators' pasts. It is a work that might well work well in an undergraduate course on medical ethics, since it vividly illustrates new ethical clashes between children and parents that have been made possible by modern medical advances. The book is a best-seller and the hundreds of reader reviews on Amazon.com are very positive.

Nevertheless, while My Sister's Keeper is gripping and explores important issues, I had a strong negative reaction against it. The carefully orchestrated crises of the characters with a series of dramatic revelations through the book make it melodramatic and convey a sense that the author has her priorities wrong. She seems to prefer surprising the reader to really exploring the emotional depths of the problems her characters are dealing with. It's a "ripped from the headlines" aesthetic that makes the story topical but shallow. One can easily imagine the story being turned into a made-for-TV movie. The tragic shocker ending is especially manipulative and cheap.

This novel is not a terrible piece of writing, and there is something to be said for raising public consciousness about medical ethical dilemmas. Picoult is certainly competent at setting out the issues and bringing them alive for a wide audience. But on every page, there's an easy turn-of-phrase that rings of cliché or some twist of the plot that seems to be have included purely for effect, and after too many of these, one is relieved to finish the book.