1. One of this novel's strengths is the way it skillfully demonstrates the subjectivity people bring to their interactions with others. The motivations of individual characters, the emotions that pull them one way or another, and the personal feelings that they inject into professional situations becomes achingly clear as we explore many different viewpoints. For example, despite Julia and Campbell's attempts to remain calm, unemotional and businesslike when they deal with one another, the past keeps seeping in, clouding their interaction. The same goes for the interaction between Sara and Anna during the trial. Is there such a thing as an objective decision in the world of this story? Is anyone capable of being totally rational, or do emotions always come into play?

2. What do you think of this story's representation of the justice system? What was your opinion of the final outcome of the trial?

3. What is your opinion of Sara? With her life focused on saving Kate, she sometimes neglects her other children. Jesse is rapidly becoming a juvenile delinquent, and Anna is invisible -- a fact that the little girl knows only too well. What does this say about Sara's role as a mother? What would you have done in her shoes? Has she unwittingly forgotten Jesse and Anna, or do you think she has consciously chosen to neglect them -- either as an attempt to save a little energy for herself, or as some kind of punishment? Does Sara resent her other children for being healthy? Did you find yourself criticizing Sara, empathizing with her, or both?

4. During a conversation about Kate, Zanne tells Sara, "No one has to be a martyr 24/7." When she mistakenly hears the word "mother" not "martyr" and is corrected by Zanne, Sara smiles and asks, "Is there a difference?" In what ways does this moment provide insight into Sara's state of mind? Do you think it strange that she sees no difference between motherhood and martyrhood?

5. Campbell is certainly a fascinating character: guarded, intelligent, caring and yet selfish at the same time. Due to these seemingly contradictory traits, it can be difficult to figure him out. As he himself admits, "motivations are not what they seem to be." At one point he states, "Out of necessity -- medical and emotional -- I have gotten rather skilled at being an escape artist." Why do you think Campbell feels that he needs to hide his illness? Is it significant that Anna is the first to break down his barriers and hear the truth? Why, for example, does he flippantly dismiss all questions regarding Judge with sarcastic remarks?

6. At one point, Campbell thinks to himself: "There are two reasons not to tell the truth -- because lying will get you what you want, and because lying will keep someone from getting hurt." With this kind of thinking, Campbell gives himself an amazingly wide berth; he effectively frees himself from speaking any semblance of the truth as long as the lie will somehow benefit himself or anyone else. Did it concern you that a lawyer would express an opinion like this? Do you think, by the end of the story, that Campbell still thinks this moral flexibility is okay? In what ways might this kind of thinking actually wind up hurting Campbell?

7. It is interesting that Campbell suffers seizures that only his dog can foresee. How might this unique relationship mirror some of the relationships between humans in this novel? In what ways does Judge introduce important ideas about loyalty and instinct?

8. On page 149, Brian is talking to Julia about astronomy and says, "Dark matter has a gravitational effect on other objects. You can't see it, you can't feel it, but you can watch something being pulled in its direction." How is this symbolic of Kate's illness? What might be a possible reason for Brian's fascination with astronomy?

9. Near the end of the novel, Anna describes "Ifspeak" -- the language that all children know, but abandon as they grow older -- remarking that "Kids think with their brains cracked wide open; becoming an adult, I've decided, is only a slow sewing shut." Do you believe this to be true? What might children teach the adults in this novel? Which adults need lessons most?

10. "It's more like we're astronauts, each wearing a separate helmet, each sustained by our own source of air." This quote comes from Anna, as she and her parents sit in silence in the hospital cafeteria. Besides being a powerful image of the family members' isolation, this observation shows Anna to be one of the wisest, most perceptive characters in this novel. Discuss the alienation affecting these characters. While it is obvious that Anna's decision to sue her parents increases that sense of alienation throughout the novel (especially for Anna herself), do you think that she has permanently harmed the family dynamic?

11. During the trial, when Dr. Campbell takes the stand, he describes the rules by which the medical ethics committee, of which he is a part, rules their cases. Out of these six principles (autonomy, veracity, fidelity, beneficence, non-maleficence, and justice), which apply to Anna's lawsuit? Moreover, which of these should be applied to Anna's home situation? In other words, do you think a parent might have anything to learn from the guidelines that the doctors follow? Are there family ethics that ought to be put into place to ensure positive family dynamics? I so, what should they be?

12. Early in the legal proceedings, Anna makes a striking observation as she watches her mother slip back into her lawyer role, noting, "It is hard to believe that my mother used to do this for a living. She used to be someone else, once. I suppose we all were." Discuss the concept of change as it is presented in this story. While most of the characters seem to undergo a metamorphosis of sorts -- either emotionally or even physically (in the case of Kate), some seem more adept at it than others. Who do you think is ultimately the most capable of undergoing change and why?

13. Discuss the symbolic role that Jesse's pyromania plays in this novel, keeping in mind the following quote from Brian: "How does someone go from thinking that if he cannot rescue, he must destroy?" Why is it significant that Jesse has, in many respects, become the polar opposite of his father? But despite this, why is Jesse often finding himself in the reluctant hero position (saving Rat, delivering the baby at boot camp)? Brian himself comes to realize, in the scene where he confronts Jesse, that he and his son aren't so different. Talk about the traits that they share and the new understanding that they gain for each other by the end of the story.

14. My Sister's Keeper explores the moral, practical and emotional complications of putting one human being in pain or in danger for the well being of another. Discuss the different kinds of ethical problems that Anna, as the "designer baby," presents in this story? Did your view change as the story progressed? Why or why not? Has this novel changed any of your opinions about other conflicts in bioethics like stem cell research or genetically manipulated offspring?