Thirty-five-year-old Bardem plays 55-year-old Ramon Sampedro, a Galician who broke his neck as a young man and has spent more than a quarter of a century as a quadriplegic, confined to bed. Reflecting on his past and considering his future, he chooses to die, petitioning the courts for permission to be euthanised. His radical decision sets off controversy throughout Spain as well as in his own house, where his family and friends all have different opinions on the fate he has chosen.

While Ramon's father (Alberto Gimenez) and brother (Celso Bugallo) refuse to help him die, and his nephew, Javi (Tamar Novas), tries to understand his uncle's decision, Ramon is surrounded by women who virtually fight over him - Rosa (Lola Duenas), a single mother of two who visits him to talk about her difficult life; Manuela (Mabel Rivera), his sister-in-law who takes care of his daily needs; Gene (Clara Segura), who works for the Death with Dignity organization; and Julia (Belen Rueda, in a powerful film debut), a married lawyer with a secret of her own.