A serious case of manipulation

Sadness settles into “My Sister’s Keeper” like rain over Seattle in this troubling and troublesome drama of a dying child, the sister who has been created to save her and the family that is wasting away alongside of her.

Starring Cameron Diaz as the mother, Abigail Breslin as Anna the sister/donor and an especially fine Sofia Vassilieva as Kate, with a lifetime of pain filling her 15 years, how could you not be moved by director Nick Cassavetes’ latest effort?

That seems to be exactly what Cassavetes is asking -- no, demanding -- as he puts us directly in the path of this emotional tsunami of a film that makes his prior weepie, “The Notebook,” a tale of love and death wrapped in the arms of Alzheimer’s, look sentimentally cheerful by comparison.

It is a thoroughly modern and extremely fraught dilemma that the Fitzgerald family faces. It’s one that author Jodi Picoult first explored in her novel on which the film is based, when medical technology has far outpaced ethical debate and legal restraint on what can and should be done to save a life.

Sara (Diaz) and Brian (Jason Patric) are the perfect couple, with two perfect children, Jesse (Evan Ellingson) and Kate, until Kate is diagnosed with leukemia and their world shifts from sunny days at the beach to doctors’ offices and hospital corridors. When no genetic match can be found for much of what ails Kate, a doctor quietly suggests Sara and Brian “create” one.

That “little piece of blue sky” as her mother calls her, is Anna, made possible through the miracle of a petri dish, a lot of science and some very good timing. She is loved, that much is clear, but also used -- her blood and bone marrow siphoned off starting not long after her birth -- and she wonders, as we do, would she even exist if her sister weren’t sick. Now they need one of her kidneys in the latest bid to save Kate.

In a decision that will test the family possibly more than Kate’s illness, and what becomes the ethical core of the film, Anna says no dice and hires an attorney (Alec Baldwin) to fight for medical emancipation from her parents.

It is, of course, more complicated than that. There are multiple back stories and unspoken agendas at work, both inside the family and out, and borrowing from the book’s narrative style, the film uses voice-over to tell much of it.

Those disconnected voices floating over director of photography Caleb Deschanel’s beautifully evocative images give the film an unsettling, almost music video feel. Unwittingly, that turns out to be a gift, creating much-needed emotional distance.

There is always a fine line between moving and manipulation in telling heartbreaking stories, and it is here that Cassavetes largely fails us. Where restraint might have raised up “My Sister’s Keeper,” a heavy hand has brought it down.

Still, it is good to see Diaz tackling a role that requires more than her good looks and Crest Whitestrips smile. Her character is as close as the film comes to having a villain, unless you count the doctor who set all this in motion.

The actress finds her center in an anger born of helplessness, and it radiates in the tension in her bones and the fear in her eyes. But even as she’s grilled on the witness stand, her calculated choice of one child’s health over another exposed, it’s hard to think of this desperate mother as a monster.

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betsy.sharkey@latimes.com

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‘My Sister’s Keeper’

MPAA rating: PG-13 for mature thematic content, some disturbing images, sensuality, language and brief teen drinking

Running time: 1 hour, 49 minutes

Playing: In general release