I just don't get where the text even hints that she wants to "fight back." I think we can all agree that Himawari has a much better understanding of what's going on here than Akira or us, the players. Her line "...this isn't...how it's..." implies that she was told something about what's going on, and at least my reading is that she's been told that this is all to legitimately help Akira. While I don't work in the medical field, I have friends that do, and sometimes before you can fix somebodies body, you have to legitimately break their body. While it may not look like it to us because Akira is our POV character, this very well could be a situation of "If you don't have the stomach to do what we need to do here, then you're going to have to get out of the way."
As for choice... I would bet money Sel's read Camus. You always have a choice: you can always kill yourself. Just like both Akira and Himawari are offered non-existence but don't take it, we the players are told may times that we can....just stop playing.
Yeah, I'm open to pretty much every possibility at this point. I'm more inclined to make a list of things I'm almost positive Sel has read and/or studied. For example, I would bet that he was raised either Catholic or Orthodox, and if not, has fallen down the theological rabbit hole as it's fucking fascinating.
A lot of it comes down to the can of worms that is Himawari's character. She's appeared in many other places and to other people, and her unique desires have been hinted at. It's clear that she does not share exactly and only the desires of another. We know from this scene as well that, for one, she doesn't agree with what's happening, and two, she's afraid of the repercussions she's threatened with. She doesn't necessarily want to "fight back" in this instance, as in initiate a confrontation — although that's likely because she simply can't — but she doesn't agree with it and doesn't seem to want any part of it. She also seems to disagree with 79's view of her role in the show and why she's there, which would add context to the entire event and her involvement, but she's cut off.
She absolutely wants to help Akira, though. She cares about him and has helped him and others in the past. That's likely why she's upset with his treatment in Untitled. That doesn't necessitate her knowledge of how exactly the show is run, why it's run the exact way it is, or the knowledge/true motivations of any other character, though. She certainly knows more than us (about certain subjects,) but it's not clear how much she knows about other entities, the cycle, or therein.
On the subject of medicine, I'm not a medical professional either, but I have taken medical/field-medicine courses. Some times you do have to "break" something, but that's usually not the case. If it is here, which there may be some argumentation for in-game, it's not clear if, or how and why Himawari would know that, either. We also don't know if everyone's idea of "fixing" or "helping" Akira is the same, either. Some people seem to want to fix him by turning him into the ultimate teenage-fucking monster. We have to be careful not to ascribe knowledge to characters without seeing them possess it, and we unfortunately don't know a lot about Himawari. I recently made a post rambling about why she even exists, and that much isn't clear (in my mind.)
But I am more inclined to thinking that the game doesn't keep looping when we don't play. I think it all just...stops. I guess there are other ways to read the snatching of our eye sight, but when sight is stolen form Akira, we too cannot see. I find it cleaner to think that then when we aren't playing, within the games logic, there is no existence.
I'm sure there are contradictions to that tho, as this game is dense.
Most of what we know seems to imply that the world
does keep going, though. Some of my knowledge on this may have been changed in the early game rewrites to be fair, I'm not sure. But there have been seemingly thousands/millions of 'Akiras' that interacted with the world through the resets, but only this Akira is the one we see. It's also the one Maya says is "really you"* when she starts accepting that this Akira is the "real" Akira for lack of a better term. In the same way that the Maya in game currently isn't really "her" in Akira's eyes.
I'd agree that Sel takes a lot of influence and style from various sources, but I think it's for that reason that you can't really read the game in the same way you read a specific author or philosopher. It's frankly a jumbled mess in a lot of places, at least until we get concrete answers on some things and what they mean.
Edit: Just realized I've been listening to the untitled children's show theme for like five minutes straight...