I've been reading this thread, and what people have said both for and against this story, and you know what? I agree with both sides.
No question, I had a favorable reaction to the story overall. Especially the horror of Mira's situation -- I found myself imagining me, heterosexual male me, being locked into the nightmare of having to play like I'm attracted to a man, and then marry him, just for the chance to live again. I imagined that would be just as unpleasant for a gay woman as for a straight man.
(Now that I say it like that, I'm a little embarrassed that maybe I'm making it sound like I think a straight woman, or a gay man, would be just delighted to be in such a situation. I believe no such thing.)
The story hooked me quickly, and I found myself utterly sympathizing with Mira and her predicament. The story made the most lasting impression on me of any of the Hugo nominees. It'd get my vote if I were a Hugo voter, and I ain't no Spar-hater.
But. I realize that we only got the briefest of glimpses into the Future Society of this world, but... I was put off by the fact that there really wasn't any Future Society, apart from the dead people's ghosts riding around in their descendants' heads. I don't necessarily need to hear about flying cars or starships or androids. But I would like to hear about a society that is more different from our own than the Western world of 50 years ago, rather than a world where discussions of office parties and child care sound utterly the same as they do nowadays. I found Mira's mother's attitude to her daughter's homosexuality unbelievable, for precisely the reasons eytanz gave earlier in the thread.
My final verdict: excellent fiction, excellent horror, but somewhat so-so if I focus on the SF elements. And yet I would have voted for it for the Hugo. If you disagree with my choice, be reassured I wasn't a Hugo voter this year.