How to Die in Oregon isn’t an easy film to watch. Peter D. Richardson’s documentary focuses not on the legal or philosophical issues and ramifications of Oregon’s Death with Dignity act, but on the personal stories of people who have chosen to use the option the act gives them. Or, to be more specific, they’ve chosen the possibility, the measure of control afforded by having in hand a prescription for life-ending medication. The result isn’t a balanced, political film, but it isn’t trying to be. It’s an incredibly affecting look at the realities of fatal illness, failing bodies and the question of how much power we have over our own fates.

Much of Richardson’s film follows Cody Curtis, a Portland woman with liver cancer. Curtis is an attractive, energetic 54-year-old; she hardly seems sick as she cracks jokes and works to put everyone around her at ease. Curtis wants to live, but she wants to live on her own terms, and her struggle with her illness weaves around the film’s other stories, including that of Nancy Niedzielski, who fought to get a similar law passed in Washington after watching her husband suffer from brain cancer.

How to Die in Oregon doesn’t flinch. It opens with home video footage of Roger Sagner as he ends his life — a video Richardson later explained was shot by Sagner’s granddaughter. It was a conscious choice, the director said, to put this scene at the beginning of the film, so that Oregon wouldn’t build to a will-she-or-won’t-she dramatic peak or force you to wonder whether you’ll see anyone take the lethal prescription dose. It’s right there at the front, but gently. Richardson’s approach to the film’s close is as gentle. He doesn’t back away from the realities of Curtis’ illness, whether it’s filming as fluid is drained from her abdomen or keeping the camera running when she finally breaks down in tears. But Oregon never feels manipulative or pushy; instead, it’s respectful and cautious, painstakingly careful to avoid an exploitative or sensationalized tone. Even the sentimental score, which at first feels slightly intrusive and insistent, begins to feel comforting by the end. You need an iota of comfort in a film like this.

Richardson has little time for those who are opposed to the Death with Dignity act, though he does interview Randy Stroup, a man angered by the Oregon Health Plan’s decision to cover a prescription for a drug that would end his life, but deny him coverage for cancer treatment. (The decision was later reversed.) This isn’t a measured consideration of what the law allows and why people are opposed to or in favor of that, but an exploration of what “Death with Dignity” really means to those who choose it. It’s clear that many people are still working out exactly what it means to allow people to take their own lives. The lines aren’t clear, the emotions unpracticed: What is sad, tragic, relieving, freeing, kind, honest, horrible, difficult, understandable in these situations? How does anyone come to terms with the reality of an illness that would make a person rather exit their life?

Richardson’s film, which airs on HBO later this spring, won the Grand Jury Prize in the U.S. Documentary Competition at Sundance. At SXSW, it provoked more audience questions than any other film I’ve seen at the festival, and inspired SXSW Film producer Janet Pierson to speak about how strongly she felt about showing the film. It leaves an audience a little shell-shocked and is likely to anger those who are opposed to the act, but Oregon doesn’t present its subjects’ stories in a manner meant to convince. The stories are true, and the honesty is an argument in itself. It’s also an inspiration. For a film about death, How to Die in Oregon is awfully life-affirming.

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