Conceived as a marrow donor for her gravely ill sister, Anna Fitzgerald (Abigail Breslin) has undergone countless surgeries and medical procedures in her short life. Though their older daughter's life has no doubt been prolonged, the unorthodox decision of Anna's parents has cracked the entire family's foundation. When Anna sues her parents for emancipation, it sets off a court case that threatens to destroy the family for good in My Sister's Keeper.
If you're going to make a weepy, there's no reason you can't make it with intelligence and insight as the makers of My Sister's Keeper have done. The audience manipulation -- if one wants to call it that -- comes from your understanding of these people and how this particular family operates in an atmosphere of love and mutual concern. The tragedy that forces its way into their midst is fought with tenacity, and the conflicts within the family are portrayed in such a manner that no one is a bad guy. A film about a child with leukemia understandably has a small theatrical audience. Indeed, Jodi Picoult's novel, on which Jeremy Leven and director Nick Cassavetes' screenplay is based, might seem more at home on television, where illness, doctors and hospitals somehow feel less alarming. But My Sister's Keeper does benefit from a big-screen treatment: It allows for nuances and takes time to focus this story of an illness on all the people it affects. The movie begins with a bit of misdirection when 11-year-old Anna (Breslin) sues her parents. It looks like you're headed into a fascinating legal drama dealing with a thorny ethical issue. Anna has always known she is a "donor child." When her parents, Sara (Cameron Diaz) and Brian (Jason Patric), discover their first daughter, Kate (Sofia Vassilieva), has leukemia, they choose to conceive another child through genetic engineering who would be a perfect genetic match with Kate. Thus, Anna can donate blood or whatever else is necessary to keep her elder sister alive. The two girls love each other dearly, so Anna never complains. Then, 11 years into this routine, Kate's kidneys are failing and she'll need one of Anna's. Anna finally says no. She hires a big-shot lawyer (Alec Baldwin), whose face adorns billboards and buses all over Los Angeles, and goes to court seeking her "medical emancipation." But her mom, who gave up a law practice to care for her ailing daughter, will make a ferocious opponent. The movie isn't about a court battle. The film moves back and forth in time to show how decisions were made and how this illness impacts everyone, including older brother Jesse (Evan Ellingson), who at times feels overlooked because of his sisters' relay team in body parts. The movie reflects back on the joys and sorrows of a family and how love can be just as strong whether the answer is yes ... or no. The film takes time giving you the background on everyone, and that includes the judge (Joan Cusack) who will decide the issue and a fellow cancer patient, Taylor (Thomas Dekker) who becomes Kate's love interest. 
OK, maybe everything is a little too neat, too perfect. If you're going to be in a hospital, you would want David Thornton's Dr. Chance for your doctor. He's compassionate, honest, smart and -- this element veering into science fiction -- always available for consultation. You would want your mom to be running over everyone else's feelings in fighting for your life. You'd want a dad who continues to do his job -- as a fireman, no less! -- even though the illness marginalizes him within his own family. You'd want a brother and sister this loving, but would that ever happen? It's not surprising that Kate and Anna share a bond closer than most sisters. Though Kate is older, she relies on her little sister in every way, realizing that her very life depends on Anna. In flashbacks, through the stories of the various members of the family, we get glimpses into their personal and public lives. The two sisters endure endless medical procedures and hospital stays, which become integrated into the routine existence a close-knit family, pretending to live a normal life. A loving wife and devoted mother, Sara had left her career as an attorney to take care of her daughter, which is more than a full-time job. We feel sympathy for a woman who has become lost inside the single-minded caregiver, dedicated to one and only cause, prolonging Kate's life at all costs. The feature's male roles are not as well-defined as those of the females. Even so, Brian comes across as a solid, supportive husband, who's getting accustomed to being rendered powerless and passive by his wife's determination, which at times borders with the obsessive, forcing Sara to make illogical demands on him and the other children. There's a wonderful scene, in which Kate, toward the end of her life, wishes to spend the day on the beach, with her doctor's blessing but against her mother's wishes. The father obliges and arranges for a family picnic, while Sara throws a tantrum in public and threatens him with divorce. Hours later, Sara shows up at the beach and joins her family in a silent, powerful sequence that needs no words. The ugliness of the illness also is not depicted in great detail. Even though the vomiting is mostly offscreen it gets its point across as to how severe things can get. That the film does come by some of its tears honestly is a testament to the actors involved, including Patric as the selfless, quietly resilient dad; Diaz, whose performance improves in direct relation to her character's mood; Baldwin, offering dry comic relief as Anna's attorney; and Joan Cusack, quietly wrenching as a judge who proves sympathetic to both parties. Special mention must also be made of Vassilieva, who endures the ravages of onscreen cancer (nosebleeds, deathly pale makeup, the aforementioned vomiting) like a champ, and who as a result easily steals the film from the plucky, always engaging Breslin.
Diaz goes without any discernible makeup and even shaves her head at one point (so her daughter won't feel "ugly" following chemotherapy.) All the work pays off: This family feels like a family and not an ensemble thrown together in the casting process. When they gather around Kate's hospital bed, the whole things seems very real. Thus, the tears. There's crying and vomiting aplenty in My Sister's Keeper, and audiences may be forgiven the urge to respond in kind. Unsubtle, uneven and undeniably effective, this take-no-prisoners cancer weepie poses a fascinating moral quandary -- a girl fighting her parents for the right to control her body while her older sister wastes away from leukemia -- as a mere pretext for a full-scale assault on the viewer's tear ducts. To the extent that many will deem the assault highly successful. While this film is destined to make you shed a tear or two, there are some scenes that will make you laugh as well as to not make this a total heart-wrencher. This is definitely one that should not be missed, just make sure you bring plenty of tissue. You'll definitely need it. A tearjerking 5 on my "Go See" scale.
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