I can't tell if I would have liked this less or more without having read the rest of the series. On the one hand, the earlier books set the bar awfully high. On the other hand, many of the recurring characters and motifs here would be awfully flat without previous encounters. But is having introduced characters in earlier books really an excuse to leave them flat? Mark and Kareen hardly existed in this book (and weren't really needed plotwise) and Ekaterin might as well have not been mentioned. It was disappointing that so much time had elapsed since the last book. And why have it be four-children-later if the children aren't in the book at all?
As always (in this series, that is) Bujold does some imaginative world-building and slips in some fascinating discussion points, in this case about life, death, and age. But the levels of both humor and and emotional intensity weren't where they are in earlier installments, so overall I found this book a bit disappointing. However, I recall that there were a couple later books in the series that I liked better on rereading, so I look forward to giving this one another chance in a year or two.