We're told from the very beginning that young Kate has Leukemia and yes, she's dying. This presents with it a domino effect on the family, all of whom are still in denial that she'll be taken away from them so deep in to her childhood. Why? Because she has a sister named Anna who was genetically designed to serve as a matching donor for her. This denial has led to no sense of happiness for everyone. Mom Sara and dad Brian are basically closed off from their emotions as resentment builds, brother Jesse has basically been pushed to the wayside in spite of his reckless habit of staying out at all nights, and most surprising, sister Anna is hazy on her purpose in life and among her family. After being used and treated as a testing subject, she declares medical emancipation through a famous lawyer who agrees to take on her case after hearing of the trauma she's been through. But "My Sister's Keeper" is not completely about a trial. What it is is about letting go and admitting to ourselves that sometimes life is stronger than love and fighting medical battles. Sometimes it's just time to go, no one can explain why. Through the evident denial and petty bickering we're taken back and forth in time to explore how sister Kate handled her early stages of Leukemia and (most disturbing) how Anna played a part in helping her sister get through her illness.

There are nothing but strong performances here but Breslin and Sofia Vassilieva are perfect as close knit sisters who depend on each other for some semblance of hope in her gradually deteriorating condition. Diaz and Patric are also very strong here, respectively. Their relationship is complex and always opposite sides of the spectrum when applied to Kate's healthy struggles. Cassevetes doesn't mind displaying heart break and cold hard reality in his film and this keeps the audience from feeling manipulated. In theory the movie is a tearjerker but one that's more subtle and calculated in its sadness. "My Sister's Keeper" will hit the heart for many who watch as two parents prepare to say goodbye to their daughter and struggle to find a reason to go on with their life. Going back and forth we start to see separate instances in Kate's life where she partakes in typical youthful activities, but the script soon finds connecting instances that bring it all together and focus in on a family who choose to hold on to her as long as possible until finally the come to terms with the inevitable. This makes for some truly heartbreaking material that surprises since a film with this premise could have easily become melodramatic swill had it not been guided by the soulful writing.

A real surprise for 2009, "My Sister's Keeper" is a gentle drama with its emotions worn on its sleeve. Strong performances, and a subtle script make director Cassavetes film one of the better tearjerkers of the year.