Brian (Jason Patric) and Sara (Cameron Diaz) would seem to have the ideal life.

Brian is a firefighter, Sara a lawyer. They have a young daughter, Kate (Sofia Vassilieva), who is beautiful and vibrant.

Ah, the perfect life.

Alas, perfection is not meant to be and Kate is diagnosed with a form of leukemia. Encouraged to explore experimental alternatives by their physician, Brian and Sara have a child in vitro, Anna (Abigail Breslin), who grows up knowing she is to be a donor child genetically engineered to be a perfect match for all of Kate's medical needs.

Blood? They are a perfect match.

Stem cells? Perfect.

Bone Marrow? Again, a perfect match.

A kidney?

"Hold on," cries Anna. "Enough is enough."

Based upon a 2004 novel by Jodi Picoult, "My Sister's Keeper" is the saga of the Fitzgerald family and their fight to keep alive a teenage daughter against seemingly insurmountable odds.

It works...for awhile, anyway. Kate has lived far longer than anyone expected, but in her late teens her body begins to shut down and she requires a kidney to have any hope of survival. Again, the family calls Anna into action to be the donor of her sister's kidney.

Anna refuses. She hires a lawyer (Alec Baldwin) to help her obtain medical emancipation, an act that seems initially a tad callous despite the horrific medical procedures she has endured on behalf of her sister throughout her eleven years.

Director Nick Cassavetes has directed both a weepy family drama ("The Notebook") and a film that delves into medical ethics ("John Q"). With "My Sister's Keeper," Cassavetes attempts with moderate success to take both approaches into dealing with the Fitzgerald family dilemma.

Is "My Sister's Keeper" an exploration of medical ethics and moral dilemmas?

Yes, indeed. Initially, anyway.

Is "My Sister's Keeper" a powerful family drama exploring the inner workings of a traumatized family?

At times, yes.

Is "My Sister's Keeper" a legal drama journeying through the court system and often harrowing decisions left in the hands of individuals themselves who are, at times, as wounded as those they serve?

Yep.

Truthfully, Cassavetes can't seem to decide what he really wants "My Sister's Keeper" to be and it's that lack of consistency that most plagues the often powerful, tender, moving and evocative film.

"My Sister's Keeper" works far more than it should, mostly owing to the strength of its ensemble cast and Cassavetes' ability to construct scenes that tug at the heartstrings relentlessly.

Early on, it appears that "My Sister's Keeper" going to fall closer to "John Q" on the cinematic spectrum. In case you're wondering, that's not a compliment. My companion for the evening, in fact, fell asleep during the film's first third, however, by film's end this same companion could be seen dabbing at his eyes with tears flowing.

These early scenes seem to have as their primary goal to establish the strained family dynamic, seen mostly through the eyes of a defiant 11-year-old and a shrill, irritating mother with a seemingly abusive inability to let go. When the Leukemia initially goes into remission, the family dynamics calm and the true heart of the film begins to reveal itself.

The mother, despite her obviously complicated grief, truly loves her daughter and has given up virtually every aspect of self-identity to advocate for her.

Anna, despite her seemingly self-centered gesture, loves her ill sister madly and, over the course of the film, we learn just how significant a role she has played in Kate's daily life.

Kate, on the other hand, is just plain tired. She struggles to balance the unreasonable demands of her affluent father's side of the family with the differently unreasonable demands of her mother's relatives. Caught in the middle, Kate seems to crave the only thing she'll likely never have...a sense of normalcy.

It is during Kate's period of remission that "My Sister's Keeper" begins to really take flight as we see a budding romance between Kate and another Cancer-stricken teenager, Taylor (Thomas Dekker). While these scenes initially feel a bit awkward as the two physically appear drastically different in age, it is these scenes that most ground "My Sister's Keeper" into a heartfelt, human drama delving into the emotional, legal, moral and everyday intimacies of living with a terminal illness.

Of course, it is to be expected that the remission will not last and it goes without saying that a romance between two terminally ill young adults will be ill-fated.

As this relationship weaves itself through these young lives, we begin to see each member of the Fitzgerald family differently and realize that, despite their differences, they are a family.

While Sara is initially written almost obnoxiously over the top, this is Cameron Diaz's finest performance in years and a reminder of just how wonderful she can be in the right film.

Likewise, Abigail Breslin again shines in the type of role that used to be automatically given to Dakota Fanning. Breslin's Anna is both fiercely determined and powerfully loyal even as her story continues to unfold.

The true revelation of "My Sister's Keeper," however, is Sofia Vassilieva, most known to American audiences for her work on television's "Medium." In a role reportedly turned down by Dakota Fanning, who didn't want to shave her head, Vassilieva is utterly heartbreaking and astounding and even celebratory. While the others around her grapple with death, Vassilieva's Kate is quietly celebrating life in all its simple glories. While Cassavetes often takes these celebratory scenes over-the-top, Vassilieva is fantastic in them.

Jason Patric, as a loyal and always present father, provides a quiet contrast to Diaz's histrionics. Among the family members, only the brother, Jesse (Evan Ellingson), seems woefully underdeveloped with a series of side scenes that feel disjointed and without purpose.

As the lawyer with a not so stellar reputation, Alec Baldwin provides much of the film's comic relief, while Joan Cusack shines as the judge who seems to understand both sides of the dilemma.

Tech credits are generally solid, though Cassavetes massively over-utilizes musical montage scenes meant to provide unspoken plot exposition and evoke strong emotional responses. While Cassavetes used this approach in "The Notebook," he plugs in a montage virtually every few minutes throughout the film to the point that it begins to feel intrusive. Aaron Zigman's original score is a nice complement to the film's stark humanity, while Caleb Deschanel's lensing fits the mood nicely.

Fans of Picoult's novel are likely to be at least modestly disturbed by the liberties that Cassavetes takes with the material, but those going in fresh will likely find much to appreciate about "My Sister's Keeper." Flawed, yet undeniably moving and involving, "My Sister's Keeper" is a solid alternative for those wishing to avoid the "Transformer: Revenge of the Fallen" chaos this weekend. While it's unlikely to do even half of the "Transformers" box-office, "My Sister's Keeper" has potential as a sleeper with a longer shelf-life on home video.

© Written by Richard Propes
The Independent Critic