Nobility in the face of death or disease is nothing new to the movies.

Julie Christie played a woman slipping into the fog of Alzheimer's in "Away From Her," while Meryl Streep was a wife and mother dying of cancer in "One True Thing" and Daniel Day-Lewis won an Oscar as an Irishman with severe cerebral palsy who learned to write and paint with his toes in "My Left Foot."

However, it's unusual for a child to look into the face of death and do it with grace, as happens in the weeper "My Sister's Keeper," based on the Jodi Picoult novel. Sobbing and sniffling could be heard during a preview and most of my mascara was gone, too, by the end.

"My Sister's Keeper," directed by Nick Cassavetes ("The Notebook"), deals with parental love and fierce determination, sibling sacrifice and responsibility and how a single sick child can send fissures and fractures through a family's foundation.

When energy is harnessed to keep one of three children alive, the others can feel -- rightly or wrongly -- neglected, and marriages can wither or collapse under the weight and heartache of a gravely ill child.

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'My Sister's Keeper'

3 stars = Good
Ratings explained

• Starring: Cameron Diaz, Sofia Vassilieva, Abigail Breslin.
• Rating: PG-13 for mature thematic content, some disturbing images, sensuality, language and brief teen drinking.

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When Sara and Brian Fitzgerald (Cameron Diaz and Jason Patric) learn their younger child, 2-year-old Kate, has leukemia, a physician suggests they consider conceiving and essentially engineering a third child whose umbilical cord blood and bone marrow could be a match.

And that is how Anna (Abigail Breslin) comes to be born and, at age 11, sues her parents for the rights to her own body. "I am a designer baby. I was made in a dish to be spare parts for Kate," Anna says in a sporadic voice-over.

She insists she doesn't want to donate a kidney to teenage Kate (Sofia Vassilieva), who may die without it. Lost on the family fringes is their older brother, Jesse (Evan Ellingson), who has become a ghostly presence in his own house.

Anna's lawsuit brings her attorney mother temporarily out of retirement, to face off against a lawyer (Alec Baldwin) known for his aggressive TV campaign and win-loss record. They find themselves in front of a judge (Joan Cusack) who understands the sting of loss.

Like gentle ocean waves, "My Sister's Keeper" moves back and forth in time, from Kate's diagnosis to her remission and relapse and first love. "I don't mind my disease killing me, but it's killing my family, too," Kate suggests.

As with Picoult's book, "My Sister's Keeper" springs a surprise but abandons the novel's daring and tragic twist for an ending that's more predictable and, perhaps, palatable. I wonder how audiences would have reacted if the screenplay by Jeremy Leven and Cassavetes had been absolutely faithful.

Fans of the TV series "Medium" will recognize 16-year-old Vassilieva as the actress who plays Ariel Dubois, the eldest daughter of Patricia Arquette's psychic. For the movie, she shaved her eyebrows and waist-length silky blond hair, donned contacts to make her eyes bloodshot and cloudy and wore makeup that mottled her face.

Whether on TV or film, Vassilieva projects vulnerability, her tangle of emotions like veins almost visible under the skin. If she didn't look like a leukemia patient, "My Sister's Keeper" would never work.

Breslin, an Oscar nominee for "Little Miss Sunshine," is 13 (the same age as the character in the book) but plays an 11-year-old with maturity and intelligence. Ellingson, who looks like he could be Diaz's son, does a nice job as the lost soul but his role was meatier and darker on the page.

Patric provides quiet support as Brian, a firefighter, while Diaz is the backbone of the battle to keep Kate alive. It's a welcome departure for Diaz, who wraps herself in a daily uniform of jeans, T-shirt and oversize cardigan sweater, as if telegraphing she has more important matters on her mind and perhaps warding off the hospital chill.

"My Sister's Keeper" is matter-of-fact about vomiting and bleeding and tubes that interfere with teenage shopping expeditions. The most affecting scene, set to the Edwina Hayes' song "Feels Like Home," tracks an outing that is simultaneously joyful and melancholy.

Yes, a film about a girl with leukemia doesn't exactly scream "summer" (it really should have been released in the fall), but the power of the performances, the important questions it raises and the touching story of death and life make it worth your while. And tissues.