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It's beautifully shot and skillfully acted, but My Sister's Keeper, an earnest family-faces-cancer drama, is a bit like a real-world horror film with "heart," right down to the trick ending.

To its credit, it contains unblinking depictions of the retching, bleeding and scarring that come with extreme medication. (That's the most original thing about it.) But even if you judge it by the rules and standards of horror movies instead of family dramas, My Sister's Keeper flunks some basic tests.

Work backward from the tear-jerking climax, and you realize that the film has pulled cheat after cheat. The movie pivots on the story of Anna Fitzgerald (Abigail Breslin), a "designer baby" programmed to be a perfect genetic match and thus a bone marrow and organ donor for her leukemia-ridden older sister Kate (Sofia Vassillieva). At age 11, Anna approaches lawyer Campbell Alexander (Alec Baldwin) to sue her parents for medical emancipation. Fed up with doctors farming her for body parts, she wants to decide for herself whether to donate a kidney to her sibling.

My Sister's Keeper sets out to bring the mental toughness of a legal drama to a tale fraught with pathos. The potential for crackling poignancy is huge - especially since Anna's mom, Sara (Cameron Diaz), was a formidable lawyer herself before she quit her practice to care for Kate full time. (Her husband, Brian, played by Jason Patric, is a firefighter.)

Director Nick Cassavetes and his co-writer, Jeremy Leven, don't make good on the movie's promise. Too often, they sink into soap opera, using devices taken from Jodi Picoult's novel and broad strokes all their own, like the final narrative turnaround. Like desperate thriller writers, they withhold information to bring off their uplifting version of a feel-bad finale. They also practice the magician's trick of misdirection: drawing the audience's attention to one place while the real story builds to a climax somewhere else.

At the same time, they allow each major character, including Anna's troubled, elusive elder brother Jesse (Evan Ellingson), to present what amounts to partial testimony straight to the audience, in voice-over narration. And everyone, including Baldwin's lawyer and the key supporting character of Judge De Salvo (Joan Cusack), comes conveniently equipped with a back story that echoes the Fitzgeralds' calamities.

Although Kate's weakening body and Anna's day in court provide stern deadlines, the movie becomes oddly static. The actors rarely get a chance to dig into the material. The filmmakers burden even the most charged sequences with abrupt flashbacks or with montages set to songs more evocative than their scenes. (Especially haunting is Jimmy Scott's rendition of the David Byrne-Jerry Harrison classic "Heaven.")

When these actors do connect emotionally, they're potent. Diaz is an unexpected powerhouse: She doesn't hold anything back. She conveys the heroism and the tunnel vision of a mother's zealotry. Her confrontations with Baldwin tingle with humane commitment and intelligence. He's silky and strong as a deceptively slick lawyer whose passion equals hers. And Sofia Vassillieva is remarkable as Kate, fusing an angry young woman and a sweet, gentle little girl. Her Kate proves to be capacious in her curiosity, unbounded in her sympathy.

The film peaks when the sensitive Thomas Dekker, as her first love and fellow patient, brings out her humor and longing. Vassillieva does something vastly difficult with ease: She maintains the full personality of a person who is fading away.

Still, she can't save a movie that draws on viewers' fears of mortality and yearning for family, then doesn't give enough back. In the end, this movie operates like an emotional pyramid scheme.

My Sister's Keeper

(New Line Cinema) Starring Cameron Diaz, Abigail Breslin and Sofia Vassillieva. Directed by Nick Cassavetes. Rated PG-13 for some disturbing images, sensuality, language and brief teen drinking. Time 109 minutes.

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