Middlebrow Medical Ethics

If you travel through airports, you can’t help but notice it. Jodi Picoult’s novels are everywhere. From Charlotte to Kansas City to Los Angeles, airport bookstores are consistently stocked with three or four or more of her most recent heavy volumes of fiction. Read one and you might mutter that it seems designed for a relatively mindless flight from one coast to the other. Read several and you might agree with National Public Radio’s disparaging view that the books are “lurid tales of family strife . . . garnished heavily with medical jargon, legalese, and a punitive finger pointed at a mother.”

It’s not hard to find negative comments about Picoult’s novels. Janet Maslin, writing for the New York Times, refers to them as “tear-jerker(s) on authorial autopilot,” long-winded, perfunctory, and vapid. One blogger echoes others in declaring that reading a Picoult novel is like watching a train wreck: painful, but interesting to watch. Even so, her books are perennial bestsellers, right up there with those of Stephen King and Mary Higgins Clark. Published in more than forty languages, her last six books have sold more than five million copies in the United States alone. At age forty-two, she’s written sixteen novels, continuing a steady pace of writing one a year. Many readers opine that Picoult couldn’t have broken a sweat writing her most recent book, House Rules.

Clearly, Picoult has found a formula that works. Tragedy sparks a family drama. The chapters are narrated through separate viewpoints, each with a font change to distinguish between the different voices of characters. The characters themselves are somewhat admirable, somewhat despicable. In the end, they always suffer an alarming plot twist.

Contrived and emotionally manipulative, the stories nevertheless connect effectively with readers. Picoult’s prickly topics have been plucked right from current headlines and talk shows: transplant ethics, stem cell research, teen suicide, genetic disease, incest, euthanasia, and abandonment. Subplots meant to reverberate with the main themes of identity, regret, hope, and moral choice weave into the main narrative through intrusive flashbacks and disconnected digressions. Her books could be substantially improved by cutting half their length.

At her best, Picoult writes about the imperiled children of flawed middle-class parents. As if it is not enough that these children are saddled with parents who both care for them deeply and fail them miserably, the children are also inevitably afflicted with a chronic or genetic disease from which they cannot be rescued. Faced with tragic choices, the mothers, in particular, unerringly make the wrong choice and create a new, worse tragedy for the child and the entire family. No single horror is sufficient. Perhaps it is no coincidence that these books sell best in airports, to people who probably worry about whether they are spending enough time with their children. Although her stories are imbued with an almost frenzied worry about children, taking care of these vulnerable victims seems to be more than ordinary parents can handle.

All that said, Picoult’s plots manage to raise philosophic questions about serious bioethical issues and moral choices. In My Sister’s Keeper, published in 2004, Anna Fitzgerald was conceived out of her parents’ desperation to have a perfect genetic match to keep alive her leukemia-afflicted sister, Kate. From infancy, Anna has donated compatible fluids and body parts to her sibling. Now thirteen, Anna resists giving up a kidney when Kate needs one. When Anna sues for medical emancipation so that she—not her mother—can make decisions about her body, the family begins to unravel. Anger, hope, and despair alternate throughout the novel’s pages. Is it right to use one child as the means to save another? What should be the limits to a parent’s rights over decisions about a child’s body?

Handle with Care, published in 2009, delivers another family in turmoil over decisions about a child’s illness. Five-year-old Willow was born with brittle bone disease, a genetic imperfection that leaves her vulnerable to hundreds of broken bones as she grows. When her mother decides to sue her obstetrician—also her best friend...