The choice to die and the shame associated with suicide are at the thematic heart of Miriam Toews’s stunning sixth novel. This is not unexpected, given that the author herself has been touched by suicide (Toews’s father and sister both took their own lives), and that she has written several books involving characters in the Mennonite community struggling with mental illness.

All My Puny Sorrows focuses on Yoli, a writer who travels from Toronto to the Winnipeg bedside of her older sister, Elf, who has attempted, not for the first time, to kill herself. Yoli is dealing with an impending divorce, a faltering career, a tendency toward promiscuity, and the lingering self-loathing brought on by her Mennonite upbringing. Elf’s life, by contrast, is seemingly ideal. She is a famous and respected concert pianist, with a beautiful home and an upcoming tour. Behind the facade, however, lies a fathomless and inconsolable sadness, similar to that which gripped the sisters’ father and pushed him to end his life.

Having already experienced her father’s depression and death, Yoli is all too familiar with the darkness consuming her sister, but despite her anger, she refuses to pass judgment on Elf, even when the latter makes an unimaginable request. Yoli is faced with an agonizing decision: to help her sister die in a dignified way, or deny Elf her wish and wait for what Yoli knows is inevitable.

Toews’s most famous novel, A Complicated Kindness, tells the story of two adolescent sisters struggling to assert their independence and flee the confines of their Mennonite village. In a sense, All My Puny Sorrows is the story of those sisters, or women strikingly similar to them, now in their forties and still trying to figure out how to navigate life’s hardships. It is a heartbreaking illustration of unselfish love that transcends illness and death; it is also a critical commentary on the treatment of suicidal patients under psychiatric care. Toews offers a nonjudgmental reflection on the choice some make to end their lives and asks, “How could you understand what another person’s suicide means?”