The film is at its strongest when it stays closest to the book and the first person viewpoint. Jean-Do's humor, perspective, and sometimes poetic narrative carry the day. To be fair, the embellishments work too, each dream and memory sequence, each scene shot from outside Jean-Do's perspective, adds to his story. The scene in which the mother of Jean-Do's children must function as his voice in a telephone conversation with his mistress is a sledgehammer to the gut. The film's only significant weakness is the result of an editing dilemma. Each scene works, but some scenes drag the viewer perilously close to the edge of pathos, and two hours on emotional edge creates a resistance that begins to dull the film's effectiveness. The scenes taken most directly from the author's perspective best avoid this dilemma.
So, you are thinking, why would I want to see a low budget, independent, French language film with subtitles about a dying paraplegic instead of Die Hard 4 when I only get out to the movies once every two weeks. Two reasons. First, every actress in this film is beautiful and exceptionally talented (we won't even mention the subtle score or the extraordinary performance by Mathieu Amalric as Jean-Dominique Bauby - all he's got to work with is one eye - My Left Foot was a comparative piece of cake). Second, before watching this movie, I would have left a living will, instructing all concerned to "pull the plug" if I suffered a stroke that left me in Jean-Do's condition. Now, I'm rethinking that instruction.