Twenty-six years ago, Ramón Sampedro (JAVIER BARDEM) was a dashing young man with a beautiful girlfriend and a job as a boat mechanic that allowed him to see the world. A diving accident, however, resulted in a broken neck, leaving him as a quadriplegic. Not wanting to suffer what he claims is the indignity of using a wheelchair, Ramón spends almost all of his time in bed, cared for by his sister-in-law Manuela (MABEL RIVERA) and nephew Javi (TAMAR NOVAS).
After all of the intervening time to contemplate his state, Ramón has decided he wants to die, much to the dismay of his older brother José (CELSO BUGALLO) and their elderly father Joaquín (JOAN DALMAU). With the aid of right-to-die advocate Gené (CLARA SEGURA), Ramón meets disabled lawyer Julia (BELÉN RUEDA) and her assistant Marc (FRANCESC GARRIDO).
As she begins working on his case, Ramón's story on TV brings various other people into his life. There's Father Francisco (JOSÉ MARÍA POU), a quadriplegic priest who wants to show that there's still a reason to live, while laid-off factory worker, part-time deejay and single mom Rosa (LOLA DUEÑAS) wants to feel better about herself by trying to convince him to live.
Despite their intentions and the women falling for him, they can't change Ramón's mind. With the aid of Julia and others, he does what he can to convince everyone that the best option for him is to die with dignity.