No male filmmaker has more consistently understood female characters and the actresses playing them than Pedro Almodóvar, a virtue that rescues the treasured director’s first English-language feature from the reams of prose-style dialogue in its establishing scenes. Adapting Sigrid Nunez’s 2020 novel What Are You Going Through, in which a terminally ill woman asks an old friend for her companionship as she prepares to end her life, the Spanish writer-director takes time to shake off that stilted, page-bound quality. But a change of scene and the luminous screen presences of Tilda Swinton and Julianne Moore breathe life into The Room Next Door.

Almodóvar got his feet wet working in English with two shorts — The Human Voice, a Cocteau adaptation exploring the line between true feeling and artifice, styled as a virtuoso performance piece for Swinton; and the playfully horny queer cowboy love story Strange Way of Life, with Ethan Hawke and Pedro Pascal. Both those films embraced melodrama with characteristic Almodóvarian passion.

In The Room Next Door, melodrama and theatricality are tamped down, resulting in a very measured drama about life, death and the responsibilities of friendship that at times risks becoming an arid intellectual exercise. Without two such accomplished lead actors, it’s doubtful this would work at all.

What does work right from the start is the director’s customary attention to visual detail, to the ways that spatial lines, symmetry and especially color can give shape to his characters’ inner lives. Only in an Almodóvar movie might you find a hospital patient dressed in dazzling shades of firetruck red and azure and magenta. (Bina Daigeler did the eye-catching costumes.)

Production designer Inbal Weinberg makes every meticulously dressed interior a distinctive frame in which to observe the two women protagonists. But it’s when the story leaves Manhattan and heads to a luxury modernist rental near Woodstock that it starts acquiring emotional vitality.

Tucked away in a woodsy setting, that house is an architectural delight, a cluster of what look like cubic boxes in wood and glass almost inviting us to arrange and unpack them, while freeing up the movie to do the same with its characters.

The interiors continue that function with sharp geometric lines to dissect the women. A shot in which they lounge side by side on upholstered deckchairs, mirroring a copy of Edward Hopper’s People in the Sun hanging inside, becomes an ingenious trick of color-blocking. DP Eduard Grau’s camera moves in close, separating the characters from their surroundings along with any last vestiges of distance between us and them.

Moore plays successful writer Ingrid, signing books at a Rizzoli author event when she learns that her friend Martha (Swinton) has been hospitalized with cancer. The two women worked together decades ago at Paper magazine but have fallen out of touch in more recent times, partly because Martha’s work as a New York Times war correspondent kept her on the move.

The awkwardness of semi-estrangement melts away instantly when Ingrid visits the hospital and Martha explains that she’s agreed to be a guinea pig in an experimental treatment for her Stage 3 cervical cancer.

Unfortunately, she then launches into a lengthy background recap that feels almost as if Swinton is reading book excerpts off cue cards. Also, much of the information Martha shares would surely be familiar to Ingrid because it predates their time as magazine colleagues. It’s in this opening stretch in particular that you might wish Almodóvar had worked with a co-writer able to loosen up the English dialogue and make it more fluid.

Martha reveals that she has minimal contact with Michelle, the daughter she had in her teens, for whom she never developed much maternal feeling. She says Michelle resented not having a father ever since she was a little girl. Scenes from the past materialize revealing Martha’s brief relationship with the father, his return from Vietnam as a damaged man and the tragic accident that took his life. This allows for a striking visual set-piece even if it feels extraneous.

The same goes for Ingrid’s discussion, when they meet up again outside the hospital, of her next book project, a semi-fictionalized account of the unconventional love story between Bloomsbury Group figures Dora Carrington and Lytton Strachey, who was gay. Martha responds by recalling her one, unpublished foray into fiction with a different queer romance, inspired by two Spanish Carmelite missionaries she met in Baghdad.

Digressions into other people’s stories are a part of Nunez’s book, but here they just seem to be stalling for time before Martha makes the request of Ingrid that we can clearly see coming.

She explains that the treatments have failed and the cancer has spread, admitting that war was as much an adrenaline rush as a horror but she’s no stoic when it comes to pain: “I think I deserve a good death.” Martha has gotten hold of an illegal euthanasia pill and says she’s been ready to go since her first diagnosis. But she wants a friend to be in the next room when she takes it, flinching at the thought of a stranger finding her body. And she wants to do it in a place where she has no history.

Ingrid has just published a book about her fear of death, but after some hesitation she agrees to be Martha’s companion for her final month. While Martha no longer has the concentration for things she once loved like reading and writing, she finds moments of pleasure listening to the chorus of birds in the forest or watching a Buster Keaton movie late at night with her head on Ingrid’s lap.

While Martha has planned carefully to ensure that Ingrid won’t be implicated, Swinton, who has made herself look gaunt and hollow-eyed for the role, is unafraid to make the character appear selfish and insensitive to the emotional burden she has placed on her friend. Even so, there’s relatively little conflict in their time together.

Given Martha’s decisiveness, there’s no will-she-or-won’t-she tension, though that’s not something that interests Almodóvar. Nor is any morality debate around the right-to-die issue. But there’s a cumulative satisfaction in watching two infinitely compelling actresses play women negotiating questions large and small. And there’s a sad beauty in the finality of Martha’s decision.

Swinton and Moore imbue the movie with heart that at first seems elusive, along with the dignity, humanity and empathy that are as much Almodóvar’s subjects here as mortality. What ultimately makes the movie affecting is its appreciation for the consolation of companionship during the most isolating time of life.

Among the secondary roles, John Turturro does gentle, contemplative work as a former boyfriend Ingrid inherited from Martha, who now gives talks on climate change and other global crises of a world in its death throes. His irreversible loss of hope plays as a counterpoint to Martha’s. And Alessandro Nivola sketches an incisive character study in just one scene as an abrasive cop who proudly advertises his sanctimoniousness: “As a policeman, as a human being and as a man of faith.”

The movie feels sometimes subdued to a fault and could have used a few more notes of gallows humor to vary the tone, but it benefits enormously in terms of emotionality from the luxuriant carpeting of Alberto Iglesias’ score. Grau’s sedate camerawork has a contrasting calming effect, suggesting peace for Martha and sorrowful acceptance for Ingrid. The production appears to have shot mostly in Spain with just second unit work in Manhattan, but it captures an idea of New York, if not much sense of place.

One of the most satisfying touches, injecting resonant feeling into the final moments, is a passage lifted from James Joyce’s novel and John Huston’s film of The Dead, providing a poetic coda.