Medical Emancipation of a Minor in My Sister’s Keeper vs. Real Cases

by Lauren Koopman

Introduction

My Sister’s Keeper (Picoult, 2004) follows the complicated story of the Fitzgerald family. Kate, the oldest daughter, became sick with acute promyelocytic leukemia at a young age. Out of medical options, Kate’s parents, Sara and Brian, conceived a second daughter in hopes her placental cord blood could put Kate into remission. As Anna got older and Kate’s condition relapsed, she donated white blood cells and bone marrow, yet she never gave explicit consent.

When Kate goes into renal failure at the age of 16, Anna, only 13 years old, appoints a lawyer; the novel’s focus is the lawsuit of Fitzgerald v. Fitzgerald, in which Anna sues her parents for the right to make her own medical decisions. While Anna’s lawyer is a locally famous man named Campbell Alexander, Sara Fitzgerald, a previously practicing lawyer, represents herself and Brian in the trial. Campbell spends the trial contending that Anna should no longer undergo invasive and traumatic procedures without medical benefit. Sara, the defendant, argues they were out of other treatment options and that she had the best interests of her two daughters to consider. Sara explains that the situation is a burning house with Kate in it, and the only way for her to be saved is to send in Anna (Picoult, 2004, p. 406).

Near the end of the trial, Anna reveals that she filed the lawsuit because Kate was tired of being sick and accepted that she would die. It is worth emphasizing that Anna didn’t sue her parents to keep from donating her kidney – she sued them for the right to make the decision herself. Following this logic, the judge ultimately ruled in Anna’s favor on the condition that Campbell is her durable medical power of attorney until she turns 18.

The medical emancipation of a minor is a complex issue with no single answer. While the case of the Fitzgerald family is a work of fiction, there are many real-life examples of minor emancipation for medical and non-medical issues. Is the case of Fitzgerald v. Fitzgerald realistic?

Research Review

The term must first be defined to discuss the concept of medical emancipation. In a literary sense, ‘emancipate’ means “to be free from any controlling influence” (MerriamWebster, n.d.). Regarding minor emancipation, the “controlling influence” would be the minor’s parents. However, a minor must meet specific criteria to qualify for emancipation. According to Davis and Fang (2022), a minor may pursue emancipation if they can “function as an adult before turning 18 years old” (Definition/Introduction section, para. 2). The article states that once a minor is emancipated, the parent(s) or legal guardian(s) is thereby free from responsibility relating to the minor.

Interestingly, the article also notes that unless minors are emancipated, they cannot consent to medical treatment. Of course, there are exceptions to every rule. Every US state has different laws regarding emancipation, from what considers an adolescent “emancipated” to whether a change of legal status is required. The case of Anna Fitzgerald would likely fall under the Mature Minor doctrine, which recognizes an adolescent’s medical autonomy without relinquishing parental control (Davis & Fang, 2022, Issues of Concern section, para. 2).

An article by Hanisco (2000) examines several medical cases in which adolescents were or were not allowed to make their own decisions. The article begins by discussing the average American child’s legal status and the concept of parens patriae, or the idea that there is legal authority to protect neglected populations. It later walks through the current rights of adolescents, dissecting emancipation, abortion, and personal health rights; the text concludes by mentioning the Mature Minor Doctrine. Hanisco also argues that current laws are inconsistent; the current minor is mature enough to know they want an abortion but too immature to comprehend the weight of other treatments (p. 899-932). The entire article finishes by stating that many adolescents are emotionally capable of making informed decisions about their healthcare

An article by Barnett (2013) discusses the concept of post-emancipation child support using the case of Diamond v. Diamond. Barnett examines the case of Jhette Diamond, in which the court decided Diamond’s mother met conditions to make child support payments despite her emancipation status. Jhette Diamond started living apart from her mother at 14 due to alleged substance abuse, neglect, and domestic violence. Following her legal emancipation, Diamond also petitioned to receive child support from her mother. An appeal to the Supreme Court of New Mexico led to an examination of the Emancipation of Minors Act, in which the Supreme Court decided the purpose of the act was to serve the child’s best interests, which may or may not mean continued child support. Barnett also touches on partial emancipation, which requires partial parental involvement (p. 1838). If Anna Fitzgerald were to become partially medically emancipated from her parents, it is not unlikely that Sara and Brian Fitzgerald would still be legally responsible for her.

Diamond v. Diamond isn’t the only case of partial emancipation. A law professor (Boyle, 1999) wrote an article about children in cults who used emancipation laws to get themselves out. After comparing complete and partial emancipation, Boyle discloses the reality that court proceedings regarding the medical treatment of minors are more complicated when a minor would like to refuse life-saving treatment (Medical Treatment Cases section, para. 2). Boyle argues, “When the parent-child relationship has broken down and jeopardizes the well-being of the child, the mature child should be treated as an autonomous individual” (Conclusion, para. 1). Though the Fitzgerald children are not cult members, this closing sentiment reigns true for both Anna and Kate Fitzgerald. While the novel focuses on Anna’s medical autonomy, one could easily argue that Kate is mature enough to decline life-saving treatment, such as a kidney donation. One could also argue that the parent-child relationship between Sara, Brian, and their daughters has ‘broken down’ due to conflicting interests.

Written from an oncology (cancer) nurse’s perspective, a journal entry by Tabak and Zvi (2008) details the case of a Jewish teenager diagnosed with acute myeloblastic leukemia. In this case, the parents decided to go forth with chemotherapy. Still, they rejected procedures they considered ‘useless,’ such as a Port-a-Cath (central line) insertion. The parents also requested their child not be informed of his condition. The article aims to define the nurse’s role in a similar situation. Yet, the writers argue that a mature teenager should have the same rights as a legal adult regarding medical care. The writers back this claim by highlighting that it follows their country’s nurses’ ethical code, in which patients have the right to be informed of their diagnosis and the risks and benefits of potential treatments.

Conclusion

No real-life case exactly mirrors the Fitzgerald v. Fitzgerald case portrayed in My Sister’s Keeper. However, real law cases similar to that of Fitzgerald v. Fitzgerald support the idea that complete or partial emancipation of a minor is possible. Davis and Fang (2022) describe the Mature Minor Doctrine, which specifies that an emancipated minor may be allowed to make medical decisions while remaining under a parent’s care, like the outcome in Anna’s case. Hanisco (2000) argues that the current laws around minors choosing medical treatment are inconsistent and that if minors can obtain an abortion, they should be allowed to make other major healthcare decisions. Barnett (2013) examines financial child support following minor emancipation. This concept suggests emancipation does not always terminate parental responsibility. The final source (Boyle, 1999) reviews how children of cult members use emancipation laws to free themselves; the conclusion contends that if the well-being of a mature minor is jeopardized, said minor should be allowed to make their own choices.

My Sister’s Keeper is a New York Times best-selling novel published in 2004 that continues to touch readers. Many readers are drawn in by the complex and emotional family dynamics; Picoult displays such dynamics through both character discussions and the Fitzgerald v. Fitzgerald case. Picoult manages to craft a relatively realistic story while keeping the audience hooked.

References

Barnett, L. C. (2013). Having their cake and eating it too? Post-emancipation child support as a valid judicial option. University of Chicago Law Review, 80(4), 1799-1840.

Boyle, R. A. (1999). How children in cults may use emancipation laws to free themselves. St. John’s University School of Law, 16(1), 1-32.

Davis, M. & Fang, A. (2022). Emancipated Minor. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK554594/

Hanisco, C. M. (2000). Acknowledging the hypocrisy: granting minors the right to choose their medical treatment. NYLS Journal of Human Rights, 16(3), 899-932.

Merriam-Webster. (n.d.). Emancipate. In Merriam-Webster.com dictionary. Retrieved December 12, 2022, from https://www.merriam-webster.com/dictionary/emancipate

Picoult, J. (2004). My sister's keeper: a novel. Washington Square Press.

Tabak, N. & Zvi, M. R. (2008). When parents refuse a sick teenager the right to give informed consent: the nurse's role. Australian Journal of Advanced Nursing, 25(3), 106-111.