At eleven years old, Anna Fitzgerald is a very important person. Her older sister Kate is suffering from leukemia, and now her kidneys have failed. Anna can save her sister’s life by donating one of her kidneys. A daunting prospect for a young girl? Maybe, but this is Anna’s purpose in life. You see, she was conceived via in vitro fertilization to be a genetic match for Kate. She’s been in and out of hospitals all of her life providing blood and bone marrow donations. This is just the next step as Kate’s parents struggle to save the life of their eldest child.

The situation is about to get tricky, though, as Anna wants to be more than “spare parts” and is ready to go to court to fight for medical emancipation. She scrapes together enough cash to hire attorney Campbell Alexander – played by Alec Baldwin – to file the case on her behalf. This bombshell rocks the family to its core and it’s just the tip of the iceberg. With Kate’s time running out, everyone involved is going to have to radically examine their priorities and answer for themselves what’s most important in life… and death.

Let me just say starting out that I had reservations about My Sister’s Keeper before I popped the DVD into my player. The film stars Cameron Diaz as Sara, the mother. I can appreciate her talents in light comedies but this film is anything but. Then you’ve got a plot that’s built around two young actors, Abigail Breslin as Anna and Sofia Vassilieva as Kate. Young actors can be risky; in a dramatic piece like this they can make or break the film.

I’m happy to report that my fears were unfounded. The acting here is top notch across the board. Sofia especially knocked my socks off with her portrayal of a young woman dealing with cancer. It is a raw and decidedly unglamorous performance and it had to have been grueling at times. I also enjoyed a small role from one of my personal favorites: Joan Cusack as Judge De Salvo, a woman dealing with emotional turmoil of her own.

My Sister’s Keeper is a film that meanders quite a bit. The main plot—Kate in the hospital waiting for a kidney, the lawsuit going to trial and the ultimate resolution—is interspersed with flashbacks of past events from the point-of-view of the various characters. Director Nick Cassavetes also makes frequent use of voice-overs. Both techniques can be more of a crutch than an effective narrative technique but they worked for me here. These are characters you hopefully care about, and Cassavetes gives you enough of the backstory that you come to understand some of the choices and decisions being made.

If you’re getting the idea that I enjoyed this film, then you’re right on the mark. I did, a great deal. It’s not a perfect movie by any means, though. I thought the final act seemed rushed and was far less satisfying than the opening acts. This is a flaw that affects too many movies in my opinion. Why film-makers lavish time and attention in building a story in the first part of a movie only to toss it away and see how fast they can get to the end in the later stages is a mystery to me.

That quibble aside, My Sister’s Keeper is a powerful film. I think the questions about morality and ethics when trying to save your child, about the struggle to protect a life at all costs, and the timing and approach in transitioning from fighting to live to preparing to die are compelling and thought-provoking. If these issues don’t raise questions in your own mind and pull a few heart-strings then you’re just not paying attention.

My Sister’s Keeper is rated PG-13 for “mature thematic content, some disturbing images, sensuality, language and brief teen drinking.” Cancer is not pretty and this film doesn’t sugar-coat it. I didn’t find anything offensive here but some of the scenes might make you uncomfortable.

Courtesy of the distributor, Michael screened a promotional DVD of My Sister’s Keeper.