There was a lot to like about this story, but the principle ethical dilemna, as presented in the story, didn't resonate with me.
There is very little to agonize over here. Esefeb cannot tell hallucinations from reality, she lives in her own excrement, and she has minimal recognition, at best, of her own family. Her baby brother is dying, and neither she or her mother is even aware, or would likely even care in the least if they knew. But, in some sense of the word, she is happy in her viral, delusional state. Still, the only thing that would justify withholding a cure would be if all of the alternatives left Esefeb and the others just as they are now, only less happy. But that wouldn't really be a cure. In losing her delusional happiness, Esefeb has the opportunity for another kind of happiness, and if I am being judgmental in saying it is a better kind of happiness, so be it.
If a loved one of yours was brainwashed by a cult to the point where they no longer recognized you, no longer could take care of themselves or others, or have even the slightest independent thought, but wore an expression of beatific rapture all the time, would you agonize at all over whether you should just let them be? Would you be happy for them? Would you join them?
To go to the extreme case, if I become brain dead, please shut off my life support. Don't hook me up to an orgasmatron and call me happy.
I think I am getting into rant territory, and there is no need for that. I certainly believe that there are many cases where our right to interfere with the choices another person has made is something that must be agonized over. At what point do we have the right/obligation to interfere with someone's drug addiction, if at all? Do we have the right/obligation to force psychotropic medications on a person with schizophrenia? The hypothetical cases are endless, and the complexities are exceedingly intricate and intriguing.
However, as the case chosen for this story failed to engage me, the story fell a bit flat for me. I couldn't really sympathize with Esefeb when she cried for Jesse, er Ej-Es. I didn't really feel connected to Mia or any of the other characters, either. Perhaps if I listened to it again, or read it, I would feel differently. There were, after all, a number of things I did like, such as the description of space travel and its effects upon the body as well as upon our sense of time, and several other things already mentioned by others. And I also thought the reader gave a wonderful performance.
And as a final note, I think Steve would say that we absolutely should feel free to state what we like and don't like about the stories. So if we like it because the science is realistic, we should say so, or if we don't like it because the science is implausible, we should say so. I think even if we don't like a story because to us it isn't even science fiction, we should feel free to say that. I think what Steve is trying to discourage is what seems to happen quite often, where one person states they don't think a story is sci-fi because of X, and then another persons agrees or disagrees, and before you know it the thread focuses on this topic, yet again, to the detriment of other discussions about the story.
So while we could avoid it by not saying anything that might lead to such a discussion, there are other ways, too. I like the idea that anyone who doesn't think a story is science fiction or even fantasy and expresses it in their post, also state right in their post that anyone who wants to continue the discussion on whether a particular story is sf/f or not, or what sf/f is and is not in general, do so in the "sf/f or not sf/f" thread.
But then again Steve can say what he thinks much better than I can.