Most people spend their lives seeking to understand the purpose of their existence. Thirteen-year-old Anna Fitzgerald, the protagonist of Jodi Picoult's latest novel, has never for a moment questioned hers: she is the genetically perfect "match" brought into the world to keep her leukemia-stricken sister Kate alive. Physically and emotionally depleted from life in the shadow of her sibling's illness, the strong-willed Anna lashes back at the parents who conceived her out of desperation, not desire she sues them for the medical rights to her own body.

Poetic treatment of prickly topics is the trademark of Picoult, whose past bestsellers address such topics as statutory rape and teen suicide. Alternately narrated by each of its major characters, My Sister's Keeper revolves around Anna and the life-altering consequences of her very adult decision. As the novel begins, the courageous teenager enlists the legal assistance of Campbell Alexander a relentless cynic known for suing God who soon serves the subpoena that splinters the Fitzgerald family. Mother Sara, who gave up her law practice to render round-the-clock care to Kate, comes to her dying daughter's defense, while husband Brian sides with Anna. With the trial date drawing near, and Kate on the verge of kidney failure, Anna teeters on an emotional tightrope. How can she reject the person who has defined her from day one? At the hospital, Anna climbs into Kate's bed and rests her head on her chest: "I didn't come to see Kate because it would make me feel better," she says. "I came because without her, it's hard to remember who I am."

Hope and heartbreak fill the pages of My Sister's Keeper, which Picoult describes as a sort of Sophie's Choice for the new millennium. "If you use one of your children to save the life of another," the author asks, "are you being a good mother . . . or a very bad one?" Blending science, philosophy, morality and ethics, this is a thought-provoking thriller that grips and won't let go.

Allison Block reviews from Solana Beach, California.

This review refers to the novel's hardcover edition.

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