A major decision about me is being made, and no one's bothered to ask the one person who most deserves it to speak her opinion. (1.1.98)
On first reading, it seems like Anna is talking about herself. But could she also be talking about Kate? As we find out in the end, Kate doesn't want the kidney either. Is either daughter given a choice in this novel?
"[A guardian ad litem is] a person trained to work with kids in the family court, who determines what's in the child's best interests," Anna recites. "Or in other words, just another grown-up deciding what happens to me." (1.2.36)
This is a touchy subject for Anna. Even though she's ultimately going through this whole case because Kate wants her to, Anna is sick of having all her choices made for her. No wonder she worries this will never end.
"Brian," I whisper. "I've been thinking."
He shifts in his seat. "What about?"
I lean forward, so that I catch his eye. "Having a baby." (2.2.107-2.2.109)
And here we see Sara make the biggest decision: to have Anna. If she hadn't made this choice, we'd never have had a book to read. (And Anna probably wouldn't have died in the 90s, along with grunge music and slap bracelets.)
What would I do, if I found out that Izzy needed a kidney, or part of my liver, or marrow? (3.5.49)
Julia tries to put herself in Anna's shoes, but she seems to forget that Anna's shoes are much, much smaller, and Anna has someone forcing those shoes on her, instead of choosing which pair she wants to wear.
"Why don't you grow up? Why don't you figure out that the world doesn't revolve around her?" (4.3.42)
What Jesse is talking about here is Sara's tendency to choose Kate above anyone and everything else. "Growing up" means making some difficult decisions instead of relying on what feels safe.
"I know what's right for Anna," Julia tells me, "but I'm not sure she's mature enough to make her own decisions." (5.1.73)
Julia is sure of her choice here (whatever it is) but she admits later in the novel that she has no clue what's right for Anna. Is anyone mature enough to make this choice for her?
"If you want to make major decisions, Anna, then you need to start making them now. Not relying on the rest of the world to clean up the messes." (5.1.184)
Anna wants to have her cake and eat it, too. She doesn't want her parents to make decisions for her… but she still doesn't want to take responsibility. No wonder the epigraph for this section is from Hamlet. Everyone is so indecisive.
I put my hands on [Anna's] shoulders. "You don't have to do this if you don't want to, but I know that Kate is counting on you. And Daddy and me." (5.3.89)
Okay, Sara probably thinks that she's giving Anna a choice, but what she's actually giving her is a guilt trip that only the mother of a daughter with kidney failure can give.
"You admitted that you've always considered Kate's health, not Anna's, in making these choices. […] So how can you claim to love them both equally? How can you say that you haven't been favoring one child in your decisions?" (7.1.136)
Is Campbell basically acting Sara to choose who she loves more? It seems like he's asking her to love Anna more, for once, if even for just a little bit.
"It's a Solomon's choice, Your Honor. But you're not asking me to split a baby in half. You're asking me to split a family." (9.4.6)
Julia hasn't seen Sophie's Choice, so she goes a little Biblical with this reference. But the result is the same: This is a choice with huge consequences for everyone involved. Even a super long book can't thoroughly explore all the implications.