Savior Siblings

I love my brother and sisters. Our parents raised us to care for one another. Our father and mother set examples by sacrificing their own comfort to give the best to us, their children. And I love my brothers and sisters in Christ. In John 13:34, Jesus commanded us to love one another just as He has loved us. And in 1 John 3:16, He himself set the definitive example by laying His own life for us, to give eternal life to us, His children.

With such inclination and indoctrination, I wonder how much I would love if it means my own life? This calls for reflection and conviction. Conveniently, I am able to evade the questions as I deal with other pursuits and problems.

But what if saving others at the cost of our own lives is our sole, if not primary, purpose in life? And that it is neither an option nor consideration, but an imposition? In the case of Anna Fitzgerald, she says,

“I was engineered, born for a particular reason. A scientist hooked up my mother’s eggs and my father’s sperm to make a specific combination of genes. He did it to save my sister's life.”[1]

Through Anna and her family’s journey in the 2009 movie, “My Sister’s Keeper”, this paper aims to understand the biomedical ethical issue of “Savior Sibling” through different views and finally, prepare a Christian response. As a result, I hope to use the movie as an evangelism and discipleship media tool, to point others to our one true Savior, Jesus Christ.

“They (movies) are providing a resource in our personal and societal search for meaning and transcendence; they are helping those in the church develop a clearer understanding of how religion is both perceived and expressed today; and they have become the occasion for relating missionally with those outside the church and for theological reflection for those within it.”[2]

“Devoted but strong-willed mother Sara is in serious denial about teenage daughter Kate's losing battle with cancer, and as one of the girl's kidneys is failing, she assumes Anna will supply the transplant. But after years of blood transfusions and bone marrow transplants (since she was 5), Anna has had enough.

The spunky girl seeks out media-savvy lawyer Campbell Alexander to sue her parents for "medical emancipation."

Alexander, like all the characters here, has some issues of his own, though the reason for a service dog's presence is not revealed till late in the film. There's also a passing reference to his having once been involved in a case against the church.

Firefighter dad Brian and older brother Jesse, who suffers from more maternal neglect than Anna, are powerless to fight Sara's single-minded determination.

When Sara -- a former lawyer -- discovers her daughter's obstinacy, she goes ballistic and represents herself in court against Alexander. The case is presided over by a judge who is herself emotionally fragile after her young daughter's recent death in a car crash.

…as we learn more of the back-story we come to a greater understanding of the family dynamic and the factors that have driven Sara.”[3]

Although not widely publicized by the book publisher and movie producer of “My Sister’s Keeper”, several sources cite that the story was inspired by the real-life journey of the Nash family. In 2000, American parents John and Lisa decided to have baby boy Adam via test tube and genetic screening, in order to save daughter Molly from fanconi-anemia, a rare and fatal genetic disorder.[4] And while the Nash’s claim to have a happy ending, the book and movie explores dramatic ethical and moral questions that having a Savior Sibling opens up.

“When author Jodi Picoult first read about this true-life story, she began to wonder, “What if [Molly] ever, sadly, goes out of remission? Will the boy feel responsible? Will he wonder if the only reason he was born was because his sister was sick?”[5]

Jodi Picoult, best-selling and awarded author of “My Sister’s Keeper”, is known for writing stories that tackle moral dilemmas. In an interview by Religion and Ethics Newsweekly, Picoult is described as “…does more than churn out best-selling novels on gut-wrenching moral dilemmas. She also forces her readers to think, even squirm.”[6] Interestingly, the American Library Association’s Office for Intellectual Freedom lists her book at the top seven “most challenged” in 2009, for reasons such as: homosexuality, offensive language, religious viewpoint, sexism, sexually explicit, unsuited to age group, violence.[7]

“A challenge is defined as a formal, written complaint, filed with a library or school requesting that materials be removed because of content or appropriateness. The number of challenges reflects only incidents reported. We estimate that for every reported challenge, four or five remain unreported. Therefore, we do not claim comprehensiveness in recording challenges.”[8]

To-date, five of her works have been adapted for the screen --- four were turned into movies for television release, and one, “My Sister’s Keeper”, into a movie for theatrical commercial release. Produced by New Line Cinema, the movie adaptation is directed by Nick Cassavetes who is known for his work in “The Notebook”, also based on a popular book. In contrast to the fame he earned from these heart-tugging productions, he gained notoriety from a recent project on incest for which he commented, “…If it’s your brother or sister it’s super-weird, but if you look at it, you’re not hurting anybody except every single person who freaks out because you’re in love with one another.”[9]

Several online entertainment news and movie reviews (such as Popsugar.com, Nytimes.com and Dailymail.co.uk) point out the ending change. As contributed and detailed in Wikipedia.com, “In the novel, Anna dies after being left brain dead from a car accident, and her usable organs are recovered with Campbell's (Kate’s attorney) permission, including the vital kidney for Kate, who goes into remission. In the film, Kate dies from her cancer and Anna does not donate her kidney.”[10]

“My Sister’s Keeper”, starring Cameron Diaz, Alec Baldwin, Joan Cusack, Sofia Vassilieva as cancer-stricken Kate and Abigal Breslin as savior sister Anna, was released with a (PG) Parental Guidance-13 rating in the US on June 2009. It is currently available through various media, hence accessible to a global market without absolute implementation of audience restriction.

Production values aside, the movie received affirmative reviews for its emotional appeal. Marshall Fine of Huffington Post describes it as, “It's not slick, it's not easy and it's aimed squarely at your tear ducts. Yet the punch that My Sister's Keeper packs is an emotional wallop that can't be denied.”[11] Whereas, noted movie critic Robert Ebert gives the movie 3.5 out of 4 stars, and closes his review with:

“The screenplay by Jeremy Leven and Nick Cassavetes (who also directed) is admirable in trusting us to figure things out. Because it’s obvious in one beautiful scene that Kate is wearing a wig, they don’t ask, “Will the audience understand that?” and add a jarring line. Routine courtroom theatrics are avoided. We learn of the verdict in the best way. We can see the wheels turning, but they turn well.”[12]

More importantly, the movie spurred thinking and discussion amongst the secular and religious with regard to Savior Sibling and its accompanying issues such as in vitro and medical emancipation.

Therefore in order to better understand Savior Siblings (otherwise known as “Designer Babies”, as referenced in the movie[13]), the following biomedical ethics issues likewise presented in the movie – indirectly or explicitly – will be defined.

“I on the other hand, am not a coincidence. I was engineered, born for a particular reason. A scientist hooked up my mother’s eggs and my father’s sperm to make a specific combination of genes. He did it to save my sister's life.”

This medical procedure is defined as “… combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus.”[15]

“IVF is the process through which a doctor/ PGD specialist places an egg and various sperm into a glass test tube (hence, in vitro) and waits for the sperm to fertilize the eggs. Multiple embryos are created through this process and then screened so that those which match the characteristics parents demand are selected to survive. The specialist chooses the embryo that is then placed back into the child’s mother, who often undergoes a normal pregnancy.” [16]

The primary reason is infertility, by couples who have tried simpler medical solutions but have failed to conceive. In recent times, IVF is already being used to create “test tube babies”[17] for homosexual couples and for the purposes of savior siblings.

Aside from purpose, several factors in IVF come into question. And as discussed in our class, one of them is the disposal of unviable embryos. In the real-life case of the Nash family:

“The Nashes created 30 embryos and went through four rounds of in vitro fertilization (IVF) to finally produce Adam, who was the match Mollie needed. Of course, the ethics of the disposition of the 29 other embryos is quite problematic. Adam was chosen, 29 other human lives were not, simply because their DNA was not able to rescue Mollie from a deadly diagnosis.”[18]

While this is an important concern, the movie does not delve into the IVF process needed to create Anna.

“I’d like to suggest something completely off the record… Have you considered having another child? …but umbilical blood can be an effective tool in treating leukemic patients. With pre-implantation genetic diagnosis, it would be a 100% match… And legally, I can’t even officially recommend it.”[19]

In a flashback, the Fitzgerald’s and Dr. Chance discuss the options for Kate’s donor. Unfortunately, no one in the immediate family is a match. And given the time-sensitivity of Kate’s situation, waiting for a donor to crop up at the national bone marrow registry is not an option. Hence, Dr. Chance recommends and guarantees help through a PGD-screened and IVF-conceived child donor. Noticeably, medical and moral considerations for the unviable embryos and the new child were not discussed.

Also known as “genetic imprinting” and “embryo screening”, PGD is a medical procedure that tests embryos created through IVF.

“It is the testing of embryos that were created through in vitro fertilization for three main things: genetic diseases (e. g. Huntington’s disease), sex-linked genetic diseases (e. g. Duchenne Muscular Dystrophy), and chromosomal abnormalities (e. g. Down syndrome). In addition to the above, PGD can currently also be utilized for sex selection, savior siblings, and selection of eye color, hair color, and skin color. Scientists predict that in future years, PGD will be able to prevent disabilities and diseases that occur after birth, such as cancers, asthma, heart disease, and strokes. Further into the future, it is predicted that complex human characteristics, such as leanness, height, temperament, and intelligence level, could be determined through PGD.”[20]

Looking back at earlier researches and reviews on PGD, such as those found in WebMD.com, it appears that the original purpose of avoiding IVF complications is now expanding to the servicing of non-life threatening cases and vain intentions. And with future technological advances, it seems we can expect more unusual justifications.

Mid-way into the movie, after Dr. Chance confirms Kate’s termination, he introduces Mrs. Fitzgerald to a home health aide. In this scene, we see the difficulty that both medical doctor and parent go through in facing death. Dr. Chance explains their job. Mrs. Fitzgerald rejects the idea. Regardless of their positions, Kate’s pending death remains. And the option to take her home, make her comfortable and manage her pain becomes a reality. In this simple but instructive sequence, the movie conveys three important concepts.

“WHO (World Health Organization) defines Quality of Life as individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to salient features of their environment.”[22]

“Hospice care provides medical services, emotional support, and spiritual resources for people who are in the last stages of a serious illness, such as cancer or heart failure. Hospice care also helps family members manage the practical details and emotional challenges of caring for a dying loved one. The goal is to keep you comfortable and improve your quality of life. Hospice programs offer services in your own home or in a hospice center. Some hospices also offer services in nursing homes, long-term care facilities, or hospitals.”[23]

Of the three concepts, this is the hardest to research and define. Melissa Barber, a writer for the Death with Dignity National Center website, states “Not only will it be different for every person, but the answer may change during the course of an illness.”[24] However she also clarifies in a blog that “Each (Death with Dignity) option centers around one common theme: patient-centered care. This care model empowers patients and their doctors to work together to determine the most appropriate treatment options for each individual patient.”[25] Paul Ramsey, in his work “The Indignity of ‘Death with Dignity’”, agrees in the difference of philosophies butalso warns us of a contradiction in terms.[26]

Perhaps the most unique element in this movie is Anna’s legal action for medical emancipation. At first, it is presented as nothing but Anna’s change of mind and heart. Later on, it is revealed to be Kate’s idea. Except for one casual conversation as they lay on the grass, we are not told how the sisters deliberated the mechanics of suing their own parents. In any case, it was a remarkable twist in the journey of their family. In fact, it also challenged court definitions, as well as the lives of the judge and lawyer involved.

“My client does not want to be legally emancipated. She still loves her parents and want to live at home. She just does not want to be cut open anymore… Limited termination of parental rights.”[28] – Atty. Campbell

…"medical emancipation" formally releases the child from some parental involvement requirements but does not necessarily grant that decision-making to the child themselves… A limited guardianship may be appointed to make medical decisions for the medically emancipated minor and the minor may not be permitted to refuse or even choose treatment.”[29]

“I’m a designer baby. I was made in a dish to be spare parts for Kate.”[30] -

Briefly, a Savior Sibling like Anna is an exact tissue match to an ill older brother or sister.[31] This child is deliberately conceived through IVF and screened through PDG for either 1) umbilical cord donation immediately after birth, or 2) the harvesting of body parts within possibly a lifetime.[32]

In the courtroom scenes, we hear that in Anna’s case, she started donating to Kate as a newborn baby, followed by years of bloodletting and bone marrow extractions, for which her permission was never sought and she even suffered through complications.

Having defined these issues, it becomes apparent that the issue of Savior Siblings has roots and impacts beyond the simple and noble perception of conceiving one life to save another. Furthermore, it affects families and societies beyond the vulnerable and underage Savior and Patient. Therefore, it becomes more compelling for us to seek a Christian view and response that considers – the sovereignty of God, sanctity of human life, stewardship and way of love [33] – Biblical foundations beyond secular factors.

Based on the movie trailer and other promotional materials, we see the main conflict as borne out of a utilitarian view. However, as we watch the full movie, we find many of the characters actually behaving based on their duties, however defined by their worldview (better yet, by the worldview of the book author and moviemakers), often times to a fault. While these distinctions are helpful, the flashbacks and character developments reveal some virtues as well, thus captivating us, the audience, to seek further reflection and discussion.

For most of the movie, it appears that Mrs. Fitzgerald is a full-time mom and homemaker. After the lawsuit is served, she comes out as her own legal counsel. Apparently, she is a lawyer by profession; she gave up her career to nurse her daughter, Kate. But even throughout the court proceedings, her duty as a parent overrides her other roles in life. And to Mrs. Fitzgerald, this “job” requires her to keep her sick daughter alive. Even at the cost of remising her equal role as mother to older son, Jesse and youngest daughter, Anna. To the extent that she does not even listen to others, even to the wishes of her dying daughter, as laid out by Dr. Chance.

Convinced at the validity of her position, this strong woman defends herself. But when put to the stand by Atty. Campbell, her arguments fall apart; her own testimony convicts herself. And consumed by her mission to save Kate, having invested all her resources and self to this cause, she at one point had to be assured of her own worth, even through the prospect of letting go of Kate to death.

Of the many characters affected by Kate’s illness, we find Mrs. Fitzgerald as the most adherent to a deontological view. Ironically, she is also the one who violates this the most. As such, she shows us how we can be selective in our principles and behavior, depending on the people involved.

For many years as a child, Kate goes through her illness and treatments as directed by her parents and physician. Understandably, she submits to their instructions without questions nor resentment. But as she grows into a teenager and “mature minor”, we see Kate growing her own mind, to the point of making light of her condition. In one humorous but telling scene, she puts apple juice into her urine sample container and teases a nurse by drinking it!

“ma·ture mi·nor (mă-chūr' mī'nŏr) Person younger than 18 years of age, who nonetheless possesses an understanding of the nature and consequences of proposed treatment.” [34]

On a serious note, Kate begins to reflect on her family situation and her pending death --- whether as an indirect function of her disease or a natural progression. And in fairness to her, while the idea of using Anna to sue their parents is by default unforgivable, we see merit in her duty. As a daughter, relieves her family from the burden of keeping her alive, especially on her younger sister Anna. As a patient, accepts the reality that her medical team has already done the best they could.

Under oath, Dr. Chance’s duty as a doctor is to treat illnesses and preserve lives. And as a professional, he is bound by ethical and legal boundaries. Hence, we see conflict when he recommends the Savior Sibling route to the Fitzgerald’s, off the record. Perhaps in his own perspective, he is doing his duty to save his young patient, Kate. But clearly, he is aware of the breach he committing. Further disappointing was his lack of disclosure with regard to the issues concerning IVF and PGD. Nonetheless, we also see him as the clinical but dedicated physician who sees the Fitzgerald’s through the beginning until the end of their journey.

For only $700, Atty. Campbell takes on Anna’s case. But he showboats through the proceedings as if it were a high profile case. Judge De Salvo and Mrs. Fitzgerald is suspicious over his intentions. But later in the movie, he suffers an epileptic attack. And there, Anna finally understands why Atty. Campbell took on her case: “It wasn’t for the notoriety. He was an epileptic. He knew what it was like not to have control over his own body.”[35] As such, he actually redeems himself by fulfilling his professional duties beyond the price tag of his services.

As expected, the judge behaves ethically. Despite a coming to terms with death, through the loss of her own child to a tragic accident, Judge De Salvo resumes her duties. Functionally, she denies Mrs. Fitzgerald’s petition for a summary dismissal and agrees to a hearing. But we also see her acting in character as she connects with Anna and Kate. In any case, Judge De Salvo

Dr. Chance presents his clinical recommendation as most beneficial for his patient Kate and the rest of the Fitzgerald's, regardless of the ethical questions that come with IVF and PGD. And counting the years that her life was extended and her family’s relief from finding a suitable donor, it seems that the doctor is right. However, he either forgets or avoids accounting for Anna… Finally, when asked in court what all of the medical procedures have done for Anna, he simply replies, “She got to save her sister’s life.”[36]

Coupled with her sense of duty as a mother, Mrs. Fitzgerald appears guided also by “the end justifies the means” thinking. Sure, it pains her to watch younger Anna suffering through the donor procedures. Despite this, she presses on with her mission to save older Kate, maximizing her authority to make decisions for her daughters. Perhaps taking it too far, as argued by Atty. Campbell.

When brother Jesse reveals Kate’s request as the real reason behind Anna’s quest for medical emancipation, he also explains Kate’s coming to terms with dying and her failed attempts to communicate this to their mother. Therefore possibly borne out of both frustration and compassion, Kate believes that the last resort to avoid more suffering for herself and her family is legal intervention. Quite ingenious for a teenager. But lacks discernment. While the prospect of release and relief is imaginable, Kate forgets or minimizes the pain and problems her loved ones would undergo through because of the court case.

Of all the characters, we appreciate Anna as the most virtuous, especially in the face of suffering. First, as sole donor to her sister, which she had no part in the decision. And second, as complainant in court, which she was agreed to. Across these difficult roles and circumstances, Anna faced physical, mental, emotional and social distresses. But she held up in love and loyalty.

With accompanying issues (Section I) and various ethics (Section II) at play, we now look to the issue of Savior Sibling through the Christian perspective. And as learned from our Biomedical Ethics and the Contemporary Church class, we now ask:

Is the practice/principle clearly supported by well-grounded biblical teaching?

Is the practice/principle compatible with well-grounded biblical teaching?

Is there a biblical/theological rationale for or against the practice/principle?

Is there extra-biblical support of the practice/principle from the study of general

Is there widespread historical acceptance and endorsement of the practice/principle within the history of the Christian church?

Simply, the answer to these is “No.” Some, however, may argue that Jesus sacrificed Himself, in fact gave His own life, that man may live, and that He calls us to do the same. But that is to take the message out of context.

1) We must not forget that Jesus is our infinite and everlasting God. Even by His death on the cross, He is not and never will be consumed.

2) We must acknowledge that Jesus submitted to the will of God the Father as a loving decision. He did not come to the world nor did He carry the cross forced.

And finally, what can we do about it as Christian faith communities? First, we can affirm some responses in the movie, particularly the under acknowledged aunt who gave up her full-time job to help Mrs. Fitzgerald look after Kate, then the “quality of life talk” by Dr. Chance and the home health aide. Both are intervention for physical, mental, and emotional problems of the sick child. Hence, both are not for the prevention of the key problem of having a savior child. And both are not intercession for the spiritual needs of everyone involved, from the sick child, donor child to the rest of their family.

In one perspective, the movie shows what merely serve to fix the consequences of an unwilling Savior Sibling situation. There is an absence of a Christian character or encounter that would have helped the family, perhaps even the medical and legal characters, realize and understand the spiritual aspect of their journey. True, they were operating in ethical duty, utility and virtue. We learn much from them. And on one hand, the lack actually emphasizes the need for spiritual guidance. But what matters for eternity remains.

Therefore here are suggestions that we hope can address the progressive issue of Savior Sibling:

PRE-SAVIOR SIBLING (As parents consider the medical procedure because of lack of organ donor for sick child.)

EARLY SAVIOR SIBLING (As parents submit their egg and sperm for IVF, followed by embryo testing.)

SAVIOR SIBLING (As parents give birth to savior child and begin blood, organ, etc donations.)

POST-SAVIOR SIBLING (In case savior child emancipates and / or sick child refuses donations.)

For all of the above, the intention is for the church to journey with the family. As long the help is welcome, the church must press on. Should it come to a point of refusal, the hope is for the church to persevere through prayers. This is not to mean agreement with the practical decisions, medical procedures and ethical stands of the family concerned. But to love and lead towards the ultimate Savior, our Lord Jesus Christ.

And for the different stages, here are biblical messages and principles that we can share through words and actions:

²⁰As for you, you meant evil against me, but God meant it for good in order to bring about this present result, to preserve many people alive. (Genesis 5:20, NASB)

²⁸And we know that God causes all things to work together for good to those who love God, to those who are called according to His purpose. (Romans 8:28, NASB)

Parents such as Mr. and Mrs. Fitzgerald carry the burden of decision-making and caring for the family. We see the toll it takes upon them as the adults in the journey. Without the knowledge of God, and in desperation, it is easier for people in their situation to take matters into their own hands, to be their own gods. Therefore it is important to assure them of the work and heart of God, in their lives and even in the history of mankind. And while difficult to express or exemplify, we must impart that God is present and purposeful even through suffering. For this message, a minister, counselor or loved one would best deliver.

²⁷God created man in His own image, in the image of God He created him; male and female He created them. (Genesis 1:27, NASB)

“Before I formed you in the womb I knew you, and before you were born I consecrated you; I have appointed you a prophet to the nations.” (Jeremiah 1:5,NASB)

For the Fitzgerald children, Jesse, Kate and Anna, it is important to assure them of their value in light of God’s creation and redemption plan. Instinctively, Kate may need more attention and edification. However, we must reach out and care for Jesse and Anna just as much. All these children must feel loved as humans, not handled as commodities. Therefore in the process of sharing these messages, it would be necessary to draw out their thoughts and feelings, plus to treat them warmly as children – not distantly as “the sibling”, “the patient”, “the donor”. These can be expressed in settings such as day care, youth fellowship and counseling.

So then each one of us will give an account of himself to God. (Romans 14:12, NASB)

Let a man regard us in this manner, as servants of Christ and stewards of the mysteries of God. ²In this case, moreover, it is required of stewards that one be found trustworthy. (1 Corinthians 4:1-2, NASB)

Primarily for the parents, biblical principles on stewardship should help them care for themselves and their children with an eternal perspective. Understanding that everything comes from and belongs to God should relieve them of unnecessary worries and vain thinking. And hopefully, they would appreciate their roles, even through suffering, as a privilege and not a burden. To communicate these, the church can provide medical and legal experts, on top of spiritual ministers.

Lastly, but more importantly, all of the above messages must be done in love. Hopefully, this love will not only make their journey light, but also lead them to the saving that all men need the most: salvation through our one true Savior, Jesus Christ. On that note, we must take caution with love as our impetus. We must proceed beyond the tract and tools of evangelism. Hence we must also persevere despite many difficulties and many distractions from the real issue of saving lives, not just for their lifetime but more so for eternity.

In summary, the biomedical issue of “Savior Sibling” is connected with other medical procedures that are likewise subject to ethical questions. Consequentially, many views are applied by various people involved. So unless one seeks to understand the core problems and different stages, our response will be more damaging than life saving.

Through Anna and her family’s journey in the movie, “My Sister’s Keeper”, we understand the plight and see several opportunities for a Christian response. Because of it we can also reflect on our own thinking and choices. And through all these, we realize that aside from the saving needed for the physical, spiritual salvation must be established. And so ultimately, we best respond to the issue of “Savior Sibling” by bringing it to the light and love of one true Savior, Jesus Christ.

Barber, Melissa. “Death with Dignity: Understanding Your End-of-Life Rights”, (I’m Sorry to Hear LLC), http://www.imsorrytohear.com/blog/death-with-dignity-understanding-your-end-of-life-rights

Cassavetes, Nick and Jeremy Leven. My Sister’s Keeper. DVD. Directed by Nick Cassavetes. Los Angeles: New Line Cinema, 2009.

Johnston, Robert K. Reel Spirituality: Theology and Film in Dialogue, Second Edition. Grand Rapids, MI: Baker Academic, 2006.

Office for Intellectual Freedom of the American Library Association: Banned and Challenged Books, “Frequently Challenged Books of the 21^st Century”, http://www.ala.org/bbooks/frequentlychallengedbooks (accessed 19 December 2014).

Ramsey, Paul. “The Indignity of Dignity of Death”, used with permission from The Hastings Studies 2 (May 1974): 209-222.

Religion and Ethics Newsweekly. Jodi Picoult, (New Hampshire: PBS, 2009), video and interview transcript posted 24 April 2009, http://www.pbs.org/wnet/religionandethics/?p=2753(accessed 15 December 2014).

Tang, Alex. Class lecture (discussion and hand-outs), TS565 Biomedical Ethics and the Contemporary Church, 1 – 5 December 2014, East Asia School of Theology, Singapore.

WebMD: Infertility and Reproductive Health Center, “Infertility and In Vitro Fertilization”, (WebMD LLC, reviewed on 21 June 2012), http://www.webmd.com/infertility-and- reproduction/guide/in-vitro-fertilization (accessed 19 December 2014).

Wikipedia, “My Sister’s Keeper (film)”, http://en.wikipedia.org/wiki/My_Sister%27s_Keeper_(film) (accessed 15 December 2014).

World Health Organization: Programme on Mental Health, “WHOQOL: Measuring Quality of Life”, (Geneva: WHO, 1997) http://www.who.int/mental_health/media/68.pdf (accessed 19 December 2014).

[1] My Sister’s Keeper, directed by Nick Cassavetes, written by Jeremy Leven and Nick Cassavetes, featuring Abigal Breslin, Cameron Diaz, Alec Baldwin, et. al., (Mark Johnson, Curmudgeon and Scott L. Goldman; New Line Cinema, 2009), DVD (C-Interactive Digital Entertainment, Philippine release date unknown).

[2] Robert K. Johnston, Reel Spirituality: Theology and Film in Dialogue, Second Edition, (Grand Rapids, MI: Baker Academic, 2006), 53.

[3] Harry Forbes, “My Sister’s Keeper”, Catholic News Service: Movie Review (2009), http://www.catholicnews.com/data/movies/09mv069.htm (accessed 15 December 2014).

[4] Amanda M. Faison, “The Miracle of Molly”, 5280: The Denver Magazine, August 2005, http://www.5280.com/magazine/2005/08/miracle-molly?page=full (accessed 15 December 2014).

[5] Chuck Colson, “My Sister’s Keeper: Building a Baby to Save a Life”, The Christian Post: CP Entertainment (3 August 2009), http://www.christianpost.com/news/my-sister-s-keeper-40048/ (accessed 15 December 2014).

[6] Religion and Ethics Newsweekly. Jodi Picoult, (New Hampshire: PBS, 2009), video and interview transcript posted 24 April 2009, http://www.pbs.org/wnet/religionandethics/?p=2753 (accessed 15 December 2014).

[7] Office for Intellectual Freedom of the American Library Association: Banned and Challenged Books, “Frequently Challenged Books of the 21^st Century”, http://www.ala.org/bbooks/frequentlychallengedbooks/top10#2009 (accessed 19 December 2014).

[8] Office for Intellectual Freedom of the American Library Association: Banned and Challenged Books, “Frequently Challenged Books of the 21^st Century”, http://www.ala.org/bbooks/frequentlychallengedbooks (accessed 19 December 2014).

[9] No author, “Nick Cassavetes Says Incest Isn’t a Big Deal, Compares it to Gay Marriage, and Asks ‘Who Gives a Dam?’,” The Huffington Post, 10 September 2012, http://www.huffingtonpost.com/2012/09/10/nick-cassavetes-incest-who-gives-a-damn_n_1871005.html (accessed 19 December 2014).

[10] Wikipedia, “My Sister’s Keeper (film)”, http://en.wikipedia.org/wiki/My_Sister%27s_Keeper_(film) (accessed 15 December 2014).

[11] Marshall Fine, “Huffpost Review: My Sister’s Keeper”, Huffingtonpost: Entertainment, 26 July 2009, http://www.huffingtonpost.com/marshall-fine/huff-post-review-imy-sist_b_220597.html (accessed 15 December 2014).

[12] Roger Ebert, “My Sister’s Keeper”, Roger Ebert.com, 24 June 2009, http://www.rogerebert.com/reviews/my-sisters-keeper-2009 (accessed 15 December 2014).

[13] Jennifer Lahl, “My Sister’s Savior”, The Center for Bioethics and Culture Network, no posting date, http://www.cbc-network.org/2009/07/my-sisters-savior/ (accessed 15 December 2014).

[14] My Sister’s Keeper, DVD.

[15] WebMD: Infertility and Reproductive Health Center, “Infertility and In Vitro Fertilization”, (WebMD LLC, reviewed on 21 June 2012), http://www.webmd.com/infertility-and-reproduction/guide/in-vitro-fertilization (accessed 19 December 2014).

[16] Mariana Do Carmo, “The Medically Modified Human: Future Children: Child Autonomy and the Rights to One’s Own Body: PGD and Parental Decision Making”, (New York: The Hastings Center and The Ethics Institute at Kent Place School, 13 February 2013), http://www.thebioethicsproject.org/essays/child-autonomy-and-the-rights-to-ones-own-body-pgd-and-parental-decision-making/ (accessed 19 December 2014).

[17] WebMD: Infertility and Reproductive Health Center, “Infertility and In Vitro Fertilization”, (WebMD LLC, reviewed on 21 June 2012), http://www.webmd.com/infertility-and-reproduction/guide/in-vitro-fertilization (accessed 19 December 2014).

[18] Jennifer Lahl, “My Sister’s Savior”, The Center for Bioethics and Culture Network, no posting date, http://www.cbc-network.org/2009/07/my-sisters-savior/ (accessed 15 December 2014)

[19] My Sister’s Keeper, DVD.

[20] Alexis Kim, “The Medically Modified Human: Future Children: The Designer Baby Technology: Does Preimplantation Genetic Diagnosis Cause Discrimination Against the Disabled?”, (New York: The Hastings Center and The Ethics Institute at Kent Place School, 13 February 2013), http://www.thebioethicsproject.org/essays/the-designer-baby-technology-does-preimplantation-genetic-diagnosis-cause-discrimination-against-the-disabled/ (accessed 19 December 2014).

[21] My Sister’s Keeper, DVD.

[22] World Health Organization: Programme on Mental Health, “WHOQOL: Measuring Quality of Life”, (Geneva: WHO, 1997) http://www.who.int/mental_health/media/68.pdf (accessed 19 December 2014).

[23] WebMD: Health and Balance, “Hospice Care”, (WebMD LLC, current as of 12 March 2014), http://www.webmd.com/balance/tc/hospice-care-topic-overview (accessed 19 December 2014).

[24] Melissa Barber, “What Does it Mean to Die With Dignity?”, (Oregon: Death With Dignity National Center, 16 September 2013), http://www.deathwithdignity.org/2013/09/16/what-does-it-mean-to-die-with-dignity, (accessed 19 December 2014).

[25] Melissa Barber, “Death with Dignity: Understanding Your End-of-Life Rights”, (I’m Sorry to Hear LLC), http://www.imsorrytohear.com/blog/death-with-dignity-understanding-your-end-of-life-rights/, (accessed 19 December 2014).

[26] Paul Ramsey, “The Indignity of Dignity of Death”, The Hastings Studies 2 (May 1974): 209-222.

[27] My Sister’s Keeper. DVD.

[28] My Sister’s Keeper. DVD.

[29] Wikipedia, “Mature minor doctrine”, http://en.wikipedia.org/wiki/Mature_minor_doctrine#Medical_emancipation, cited from Children and the Law by Douglas E. Abrams and Sarah H. Ramsey, West Group, 2003, 769. (accessed 15 December 2014).

[30] My Sister’s Keeper. DVD.

[31] Mariana Do Carmo, “The Medically Modified Human: Future Children: Child Autonomy and the Rights to One’s Own Body: PGD and Parental Decision Making”, (New York: The Hastings Center and The Ethics Institute at Kent Place School, 13 February 2013), http://www.thebioethicsproject.org/essays/child-autonomy-and-the-rights-to-ones-own-body-pgd-and-parental-decision-making/ (accessed 19 December 2014).

[32] Mariana Do Carmo, “The Medically Modified Human: Future Children: Child Autonomy and the Rights to One’s Own Body: PGD and Parental Decision Making”, (New York: The Hastings Center and The Ethics Institute at Kent Place School, 13 February 2013), http://www.thebioethicsproject.org/essays/child-autonomy-and-the-rights-to-ones-own-body-pgd-and-parental-decision-making/ (accessed 19 December 2014).

[33] Alex Tang, class lecture (discussion and hand-outs), TS565 Biomedical Ethics and the Contemporary Church, 1 – 5 December 2014, East Asia School of Theology, Singapore.

[34] Medical Dictionary for the Health Professions and Nursing. S.v. “mature minor”, http://medical-dictionary.thefreedictionary.com/mature+minor (accessed 29 December 2014).

[35] My Sister’s Keeper. DVD.

[36] My Sister’s Keeper. DVD.

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