A former defense attorney (Cameron Diaz) finds herself back in the courtroom when she and her husband (Jason Patric) are sued for medical emancipation by their 11-year-old daughter, Anna (Abigail Breslin), who is expected to donate a kidney to her dying older sister. The subsequent trial tests ethical boundaries and the limits of parental love. Joan Cusack and Alec Baldwin round out the cast in this powerful drama based on Jodi Picoult’s novel.

My wife said the book is quite a bit different than the movie.  If you want to see it fresh, stop reading now.  Otherwise, I have some spoilers below to talk about some of the ethical dilemmas from the movie.The family has 2 children–a boy and a girl.  The girl is diagnosed with Leukemia.  She needs a donor, but none of the family is a match.  The doctor says that the couple could conceive a genetically engineered baby to be a donor.  So here are the ethical questions.

1.  Is it ethical for the doctor to suggest genetically engineering for the purpose of donating?

2.  It is ethical for the couple to conceive a child for the purpose of saving another child’s life?

As the movie goes on, the genetically engineered sister becomes tired of all the medical procedures, and sues her parents for medical emancipation.

3.  Is it ethical for the parents to force a child to donate to her dying sister?

Ok, at this point, this is where the book and the movie diverge, so if you really want to watch the movie/read the book, STOP READING NOW.

The mother (played by Cameron Diaz) is a very determined mother who won’t let anything or anyone get in the way of what she believes is in the best interest of her dying child.  The dying girl tires so much of all the medical procedures and being sick all the time that she asks her younger sister to sue her parents.  They make a pact that the younger girl will take all the blame, because the mother will not accept her dying daughter’s wishes.  The whole family accepts the patient’s choice except the mother.

4.  Is it ethical to keep a person alive against their will?  Does the age of the patient have any impact on the decision?

In case you’re interested, I previously blogged about Euthanasia at Mormon Matters, comparing 4 cases.  What are your opinions?

Larry’s had some health problems, first suffering a heart attack related to diabetes last summer.  He has almost died 5 times since then, but had always recovered, and continued to attend games (in a wheelchair).  He had a setback a few weeks ago, and had his feet amputated below the knee due to diabetic ulcers.  Still, it always seemed like he would pull through.

I was surprised to learn of his death of Friday, and also surprised to learn that Larry knew his condition was terminal on Feb 12.  He had a rare disease called calciphylaxis, which calcifies blood vessels, blocking the flow of oxygen. It was discovered after his amputation wounds did not heal.  There is no cure for calciphylaxis. He could have survived a few more months if he chose to go through dialysis, but he chose not live like that.

Larry is a mormon, and I know that mormons are generally more liberal on right-to-die, and euthanasia than other religions, like Catholocism.  I don’t know if I have any Catholic readers, but I would like someone to comment on euthanasia/right to die if they are aware of the position, or if they think Larry should have kept fighting for life.  I know that there is a big controversy in Italy about a euthanasia right now.

I don’t think that people should be kept alive at any cost.  I applaud Larry for fighting to stay alive as long as he did, but recognizing when his time was up.  Sure he could have eeked out a few more months, but he was at peace with his decision, and I think he made the right choice.  Life is more than avoiding death, and I think some people place too little emphasis on quality of life issues.  I think I would have made a similar decision that Larry made.

This brings me to my next point.  The Deseret News recently ran an article on a new paradigm shift in health care.

The first, HB188, codifies the notion that normally healthy people should normally be healthy, and that overeating, lounging or smoking their way into obesity, diabetes heart ailments and other so-called diseases, which are not diseases but chronic conditions of lifestyle for most, is a key component in the ailing and failing U.S. health-care system.

HB188, which addresses the insurance industry specifically, amounts to a basic paradigm shift in Utah’s health care system for insurers and the insured with a carrot-and-stick approach: Along with offering a basic medical insurance plan for the first time, workers will able to carry coverage from job-to-job instead of drop coverage due to the cost of premiums, and it in effect forces them to stop eating themselves sick and start exercising.

In a different article addressing health care ethics,

Why does 33 cents of every medical care dollar go for end-of-life interventions that usually just prolong imminent death?

Should there be an age limit for open heart surgery candidates?

Should those who cost the system millions by eating themselves sick be singled out for an excise tax like the one proposed this year for people who smoke themselves sick?

Liljenquist is a new member of the Legislature but has experience with a health care decision that is both personally tragic and an appropriate illustration for a courageous public discussion that may help people get educated and “internalize the real costs of their choices.”

His first child died just a few minutes after being born and a few hours after he and his wife and their doctor chose not to fight to keep the infant alive. Doing so would have required costs upwards of $1 million and still probably would not have saved her life.

Care providers have told committee members that doctors are borderline miraculous at extending existence, but that doing so is often tantamount to holding a soap bubble on a grappling hook. “My brother tells of elderly folks during his residency of being kept on life support for months and months because their children felt it was their moral duty to keep them alive,” he said, noting that there is compelling duty as well to at least consider the expense of that kind of care.

Larry Miller understood that his health problems were the result of his own poor habits regarding his diabetes.

The pace he maintained at such times — and throughout much of his career — would have been hard on anyone, but especially a man with type 2 diabetes. There were days when he would rush out the door without eating breakfast, armed with only a candy bar, and by the end of the day the candy bar was uneaten and Miller had gone without a meal, risky behavior for a diabetic.

I really think that we all need to take a greater responsibility for our health.  I do think that people who engage in behavior known to cause health problems such as obesity and smoking, should pay higher premiums.  People who proactively engage in exercise programs should pay less.  I think it would provide an incentive for people to take control of their health, and I think far too much money goes into prolonging life unnecessarily.  Larry fought a good fight, but understood when to quit fighting.

I love this quote from the Deseret News:

Over the past 40 years of remarkable medical technological advances, people have tried to forget that death is part of life, Dr. Chris Cowley said. And in the process they’ve disconnected from the fact that most people, most of the time, have the greatest impact on their own well-being.

Finally, I hope all of us can end our lives feeling just like Larry did.

During one wistful moment while recovering from his heart attack, Miller said, “You know, I don’t want this to sound boastful, but I really have had an extraordinary life.”