Lived Experiences of Learning to Use a Long Cane: The Importance of Integrating Perceptual, Existential, and Social Dimensions for Active Cane Use.

How do people who are blind or visually impaired experience learning to use a long cane? This question is of paramount importance for planning and delivering rehabilitation programs and orientation and mobility (O&M) training. Until now, research into learning to use a long cane has focused primarily on technical and professional aspects, paying little attention to the lived experience of the learning activities that are offered in the field of O&M. This extensive qualitative study adopts a lifeworld phenomenological approach and sets out to examine the pedagogical processes within rehabilitation, focusing on the learning experiences of people with impaired vision. The methods used included participant observation during O&M training sessions and recurrent narrative interviews with three research subjects. The results show that learning to use the long cane has perceptual, existential, and social dimensions which are intertwined processes that relate to mind and body, body-world relations, and human existence and society. Learning to use a long cane has in this study been interpreted as embedded with cultural meaning about disability. Further, the habitual use of the cane promotes adaptation to visual impairment but also to build new body-world relations. The lifeworld theory and its methodology have contributed to theoretical evidence and rigor throughout. The results bring new interpretations to the field of O&M and are a relevant basis and valuable for pedagogical rehabilitation as it highlights the importance of taking the individual's lifeworld and needs into consideration when teaching someone how to use a long cane.

Ternary Moral Empathy Model from the Perspective of Intersubjective Phenomenology.

The phenomenon of empathy is an intersubjective process of feeling and a particular form of intentionality. Moral empathy refers to a type of empathy that can trigger moral action, with the embodied intersubjectivity laying the foundation for its emergence. This paper attempts to propose a comprehensive theoretical model of moral empathy from the perspective of intersubjective phenomenology, which includes the following. (1) The moral dimension of perceptual empathy: at the subpersonal, unconscious, and perceptual-motor level, embodied empathic practices are essential for the formation of moral consciousness and the emergence of moral empathy. (2) The moral dimension of situational empathy: following the development of shared attention mechanisms, children can direct towards the intentional objects of others through embodied situational cues to perceive the psychological state of others and generate the moral empathy of "ought", leading to dyadic morality that promotes cooperative behavior. (3) The moral dimension of narrative empathy: the narrative practices of moral empathy refer to the processes by which children could perceive and understand the moral situation of characters within an embodied narrative structure, subsequently generate prosocial motives such as empathic concern, and then accept the "objective" moral norms of the group consciousness embedded in the narrative.

Transformative and therapeutic benefits of digital storytelling: a phenomenological lifeworlds study of Patient Voices participant experiences.

BACKGROUND: References to transformative and therapeutic benefits of digital storytelling are often made, yet this remains an under-explored area, which we foreground in this study. METHODS: A phenomenological research design was adopted to explore through interview how a purposive sample of Patient Voices storytellers experienced participation in more than one digital storytelling workshop. Analysis was through thematic coding, linguistic analysis and use of van Manen's lifeworld existentials framework. RESULTS: We find that for this particular group, the therapeutic and transformative experiences that re-centre and re-frame personal meaning do so through inter-personal connections and can be understood as a process of social learning. The lifeworld existentials analysis demonstrates that a pluralist and relational conception of wellbeing holds and there is a close relationship between this and Yalom's 11 therapeutic factors. CONCLUSIONS: Drawing on group analytic literature, we suggest the concept of a social learning methodology as useful in grounding further research that seeks to understand the beneficial impacts of digital storytelling methodologies in healthcare and in contributing evidence in this field with fidelity to the lived experience as central.

The search for meaning in health care inquiries: introducing qualitative meaning analysis.

PURPOSE: To describe how Qualitative Meaning Analysis (QMA), based on a lifeworld theoretical approach, can be made accessible to students and researchers not well-versed in the philosophy of science or qualitative research. Additionally, to demonstrate that it is a more rigorous approach than qualitative content analysis in guiding healthcare inquiries. METHOD: In recent years, qualitative approaches in nurse education and research have increasingly relied on various content analytical procedures. Liberated from clear philosophical underpinnings, they offer a seemingly pragmatic stance to nursing inquiries. However, by prioritizing 'sorting content' over the exploration of meaning, there's a risk of adopting a mechanistic approach to qualitative analysis. This is problematic because we contend that the search for meaning lies at the heart of qualitative inquiry in nursing and healthcare research, dealing with existential phenomena surrounding health, illness, and care. RESULT: This paper explores the search for meaning in health care research, particularly in nursing, and introduces key epistemological aspects. It also discusses practical considerations to further familiarize and encourage the use of QMA in graduate nursing education and research. CONCLUSION: Qualitative inquiry with a focus on meaning is a powerful means when the intention is to develop person-centered care, and the relationship between the professionals and patients is in focus. Such an approach has the potential to illuminate existential suffering as well as innate health capacities in patients.

Meaning-oriented thematic analysis grounded in reflective lifeworld research-A holistic approach for caring science research.

BACKGROUND AND AIM: The aim of the present article is to describe meaning-oriented thematic analysis grounded in reflective lifeworld research and to illustrate how the thematic analysis can be integrated in the research process. The article is a methodological paper, including ontological and epistemological assumptions for lifeworld theory. Research based on lifeworld theory is directed towards lived experiences and meanings in everyday life. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and qualitative research can in particular contribute to existential knowledge needed to understand the world of the patient. DESIGN: Theoretical paper. RESULTS: Starting with a phenomenon of relevance for caring science, the article argues for lifeworld interviews as a data collection method that can contribute to depth and meaning, and then presents a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis. The research of lived experiences in caring science demands an approach that includes a reflective attitude during the methodological considerations. This article highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis. CONCLUSION: The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes.

Voices Unheard: A Reflective Lifeworld Research Study of Older Arabic-Speaking Female Migrants and Their Experience of Existential Loneliness.

INTRODUCTION: Existential loneliness (EL) is an unavoidable, deeper sense of loneliness. EL has been described as disconnection from life and the universe, experienced even in the presence of family and friends. Meaninglessness, loss of health and significant others seem to trigger older persons EL. Older Arabic-speaking women are a large migrant group in Sweden and there is a lack in knowledge about their experience of EL. Therefore, this study aimed to describe the phenomenon of EL as experienced by older Arabic-speaking female migrants. METHODS: This study was based on a phenomenological approach known as reflective lifeworld research (RLR). Ten older migrated Arabic-speaking women were included in the study. Lifeworld interviews were conducted to collect data. The data were analysed in accordance with the phenomenological RLR principles of openness, flexibility and bridling. RESULTS: This study shows that EL is experienced when there is a lack of attachment to place and people. EL is experienced more distinctively in the beginning of the migration process. It was difficult sharing feelings of EL with anyone. Feelings of meaninglessness occurred when entering a new lifeworld and triggered EL. EL was however attenuated when being able to practise their religion. CONCLUSION: Lack of attachment to place and people as well as feelings of meaninglessness brought existential loneliness to the fore for the older Arabic-speaking female migrants. There was a collision of lifeworlds not at least by the fact moving as a Muslim woman to one of the most secular countries in the world. Practising their religion attenuated their EL. To promote better health for this group of women, it is of importance to be aware of EL and its mode of expression. IMPLICATIONS FOR PRACTICE: It is crucial to let the voice of older Arabic-speaking female migrants be heard and to be aware of their experience of EL and its mode of expression in order to promote better health. Further, educational training for nursing professionals and nursing students needs to be provided to develop skills how to be aware of and address EL.

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives.

AIM: To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs). BACKGROUND: Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires. DESIGN: A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist. METHODS: Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach. RESULTS: The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life. CONCLUSION: Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person. RELEVANCE TO CLINICAL PRACTICE: The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care. PATIENT OF PUBLIC CONTRIBUTION: Registered nurses working in community home care participated in data collection.

Early social-cognitive development as a dynamic developmental system-a lifeworld approach.

Based on developmental systems and dynamic systems theories, we propose the lifeworld approach-a conceptual framework for research and a hypothesis concerning early social-cognitive development. As a framework, the lifeworld approach recognizes the social embeddedness of development and shifts the focus away from individual developmental outcomes toward the reciprocal interplay of processes within and between individuals that co-constitutes early social-cognitive development. As a hypothesis, the lifeworld approach proposes that the changing developmental system-spanning the different individuals as their subsystems-strives toward attractor states through regulation at the behavioral level, which results in both the emergence and further differentiation of developmental attainments. The lifeworld approach-as a framework and a hypothesis, including key methodological approaches to test it-is exemplified by research on infants' self-awareness, prosocial behavior and social learning. Equipped with, first, a conceptual framework grounded in a modern view on development and, second, a growing suite of methodological approaches, developmental science can advance by analyzing the mutually influential relations between intra-individual and interactional processes in order to identify key mechanisms underlying early social-cognitive development.

The lived experience of hearing loss - an individualised responsibility.

OBJECTIVE: This study aimed to provide a conceptual model to understand what typifies the lived experience of hearing loss. DESIGN: A grounded theory informed study of adults with hearing loss (n = 46) who participated in individual interviews. The data were analysed in line with the constant comparative approach of grounded theory. A substantial patient and public engagement (PPIE) strategy underpinned decisions and processes throughout. STUDY SAMPLE: Adults were recruited from age bands (16-29; 30-49;50-79 and 80 upwards) to provide different lived experience. We recruited individuals from across the UK including urban, sub-urban and rural communities and included a typical constituency of each location including black and minority ethnic participants. Our PPIE groups included adults often marginalised in research including South Asian community groups, adults in residential care and those with additional disabilities. RESULTS: We identified the consistent features of the lived experience with hearing loss, as the individualised responsibility that hearing loss confers. These are an individual auditory lifeworld; social comparison and social support; individual and patient-centred care and individual agency and capability. CONCLUSIONS: This work provides new insights for those practising audiology and highlights the importance of building social support systems through implementation of family and peer support approaches.

The Lifeworld of the Complex Care Hospital Doctor: A Complex Adaptive Phenomenological Study.

The ever-increasing prevalence of chronic conditions over the last half century has gradually altered the demographic of patients admitted to acute care settings; environments traditionally associated with episodic care rather than chronic and complex healthcare. In consequence, the lifeworld of the hospital medical doctor often entails healthcare for a complex, multi-morbid, patient cohort. This paper examines the experience of providing complex healthcare in the pressurised and fast-paced acute care setting. Four medical doctors from two metropolitan health services were interviewed and their data were analysed using a combinatorial framework of phenomenology and complexity theory. The horizon of complex care revealed itself as dynamic, expansive, immersive, and relational, entailing a specialised kind of practice that is now common in acute care settings. Yet this practice has made inroads largely without heralding the unique nature and potential of its ground. Herein lies opportunity for complex care clinicians to expand notions of health and illness, and to shape research, practice, and system design, for a future in which care for health complexity is optimised, irrespective of care settings.

Coming home: older patients' and their relatives' experiences of well-being in the transition from hospital to home after early discharge.

BACKGROUND: This study aims to investigate the lived experience of well-being among older patients and their relatives in the transition from hospital to home after early discharge. Research has shown that the transition brings severe challenges to their everyday lives. However, to date, there has been a lack of research focusing on the lived experiences of well-being during this process. METHODS: The data collection and analysis followed the phenomenological approach of Reflective Lifeworld Research. Ten in-depth interviews with older patients and their relatives were conducted in Austria up to 2-5 days after hospital discharge. RESULTS: The essential meaning of the phenomenon of well-being in the transition from hospital to home is marked by security and confidence to face the challenges following the discharge. Four constituents emerged: being calm and in alignment with the homecoming, being in familiar surroundings at home-a sense of belonging, striving towards independence-continuity of life and having faith in the future. CONCLUSION: Our findings point to the importance of recognizing the vulnerability associated with the transition from hospital to home, as it impacts the existential aspects of space and time. Facilitating a sense of continuity and belonging can foster well-being during this critical period.

A multidisciplinary evaluation, exploration, and advancement of the concept of a traumatic birth experience.

BACKGROUND: Understanding a woman's traumatic birth experience benefits from an approach that considers perspectives from various fields of healthcare and social sciences. AIM: To evaluate and explore the multidisciplinary perspectives surrounding a traumatic birth experience to form a theory and to capture its structure. METHODS: A multidisciplinary advanced principle-based concept analysis was conducted, including the following systematic steps: literature review, assessment of concept maturity, principle-based evaluation, concept exploration and advancement, and formulating a multidisciplinary concept theory. We drew on knowledge from midwifery, psychology, childbirth education, bioethics, obstetric & gender violence, sociology, perinatal psychiatry, and anthropology. RESULTS: Our evaluation included 60 records which were considered as 'mature'. Maturity was determined by the reported concept definition, attributes, antecedents, outcomes, and boundaries. The four broad principles of the philosophy of science epistemology, pragmatics, linguistics, and logic illustrated that women live in a political, and cultural world that includes social, perceptual, and practical features. The conceptual components antecedents, attributes, outcomes, and boundaries demonstrated that a traumatic birth experience is not an isolated event, but its existence is enabled by social structures that perpetuate the diminished and disempowered position of women in medical and institutionalised healthcare regulation and management. CONCLUSION: The traumatic childbirth experience is a distinctive experience that can only occur within a socioecological system of micro-, meso-, and macro-level aspects that accepts and allows its existence and therefore its sustainability - with the traumatic experience of the birthing woman as the central construct.

Lifeworld hermeneutics: An approach and a method for research on existential issues in caring science.

BACKGROUND AND AIM: The aim of the present article was to elaborate on a research approach and method called 'lifeworld hermeneutics'. Significant to lifeworld hermeneutics is that interpretation is the main methodological instrument for explaining and understanding existential research questions and lived experiences. From a caring science perspective, this often refers to research that aims to gain a deeper understanding of existential phenomena and issues, such as existential meaning of health, well-being, homelessness, lostness, suffering and ageing, as well as what it means to experience unhealthiness and illness, the need for care, and caring that responds to such needs. DESIGN: Theoretical paper. RESULT: The article briefly covers ontology and epistemology that clarifies the meaning and importance of a lifeworld hermeneutic attitude. This is followed by suggestions for how to perform a lifeworld hermeneutic study, expressed in relation to methodological principles for the interpretation, validation and structuring of interpretations. Thereafter, follow reflections on how to use theoretical or philosophical support to develop and deepen existential interpretations. The findings of lifeworld hermeneutic research consist of existential interpretations where the researcher, with an open and pliable attitude towards the phenomenon and the aim of the study, clarifies, explains and suggests new ways of understanding participants' lived experiences; the researcher should maintain such an attitude towards their understanding of the phenomenon as well. CONCLUSION: The lifeworld hermeneutical approach and method described in this article makes it possible to further deepen the understanding and knowledge about existential issues that is relevant for caring and caring science.

Home care nurses lived experiences of caring relationships with older adults: A phenomenological study.

BACKGROUND: This paper describes registered nurses' lived experiences of caring relationships in the context of homecare provision for older adults living in Denmark. With the growing ageing population throughout Europe, more older adults will require complex care solutions within already overburdened care systems. This development places demands on the competencies and organisation of homecare nurses, as they become key players in healthcare systems. Fostering caring relationships in homecare is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. For a caring relationship to be truly caring, we must understand not only the subjective experience of such a relationship but also how it is experienced in relation to and shared with others. AIM: This study aimed to describe the essential meaning of the phenomenon of caring relationships in homecare for older adults based on the lived experiences of homecare nurses. APPROACH AND METHODS: Registered nurses working in homecare for older adults were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. FINDINGS: The essential meaning of the phenomenon is described as creating an existential and embodied space in which each patient's world is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of 'at-homeness' through trusting 'the other', experiencing continuity as caring and prioritising the time to care. CONCLUSION: Caring competence in homecare for older adults relies on a nurse's ability to intertwine physical and existential care needs and articulate them in their daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence.

Lived experiences of closeness to a person using Anabolic androgenic steroids a next of kin perspective.

PURPOSE: Anabolic androgenic steroids (AAS) are used for their aesthetic and performance-enhancing effects and are associated with physical and psychological side effects. Behavioural changes/side effects as mood swings, aggressiveness, depression, potency problems, anxiety, and emotional coldness have been reported by next of kin to people using AAS. METHODS: This phenomenological study is based on the reflective lifeworld research approach. Interviews were conducted with twelve next of kin about their experiences of living close to persons using AAS. RESULTS: Next of kin to persons using AAS are particularly vulnerable because they experience little opportunity to influence their situation. Their given and safe context is lost, and their lives are circumscribed by feelings of insecurity, fear, powerlessness, and grief. Feelings of loneliness develop when their problems are not noticed by others and support is lacking from family and society. CONCLUSIONS: Our research adds important knowledge on how the use of AAS affects next of kin. Understanding is required to approach the lifeworld of next of kin with flexibility and empathy in their difficulties and vulnerability. Healthcare professionals and other concerned professions need to be aware of next of kin existential needs to be able to meet and support them in their life situation.

Balancing on life's ladder: A meta-ethnography of the existential experiences of siblings of children with complex care needs.

AIM: To synthesize and interpret existing qualitative research on the existential experiences of siblings of children with complex care needs. DESIGN: Noblit and Hare's interpretive meta-ethnography. METHODS: The study has been registered in the international prospective register for systematic reviews (PROSPERO). Noblit and Hare's 7-step procedure was followed and reciprocal translation was performed to analyse the data and develop a line of argument synthesis. DATA SOURCES: A comprehensive systematic literature search of five databases, along with extensive manual searches, was completed in November 2022. The final sample comprised 18 studies published between 2010 and 2022. RESULTS: A line of argument, expressed through an overarching metaphor, "balancing on life's ladder", illustrates the core findings of siblings' fluctuating experiences of existential well-being, and encapsulates four third-order themes: the emotional turmoil of siblings, interrupted family life, siblings strive to be themselves and siblings struggle to cope. CONCLUSION: Growing up with a sibling with complex care needs made children feel invisible, lonely and struggling to find the courage to cope. By adopting a lifeworld approach, nurses can become aware of healthy siblings' unmet needs. Future research is needed on how nurses can contribute to siblings' existential well-being, in primary - and secondary health care settings. IMPLICATIONS: The study provides insight into siblings' existential experiences and factors improving their well-being, enabling nurses to provide a more optimized lifeworld-led clinical practice. IMPACT: Healthcare, nursing education and practice should be informed by the knowledge of existential issues. Nurses are well-positioned to work alongside families to provide family-centered care. Our findings have implications for health policies tailored to the needs of children with chronically ill siblings. REPORTING METHOD: This review adheres to the Equator and improving reporting of meta-ethnography (eMERGe) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, because the data comprised previously published studies.

'Fleeing' as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care.

The aim of this study was to describe the phenomenon of "fleeing the encounter when facing resistance" as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one's emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers' self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient's lifeworld but also their own.

Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study.

BACKGROUND: Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved. METHODS: The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse. RESULTS: Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence. CONCLUSIONS: The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.

The meaning and impact on well-being of bespoke dancing sessions for those living with Parkinson's.

PURPOSE: This paper presents qualitative research findings from the evaluation of a Parkinson's Dance well-being venture in the UK. METHODS: Qualitative data was gathered to see how bespoke dancing sessions helped people with Parkinson's (PwP) to manage their conditions and improve their lives and prospects. Principles of a participatory approach were incorporated and methods included semi-structured interviewing, researchers participant observation and an elicitation-based activity. Nineteen PwP, six carers, four dance artists and seven helpers participated in the study. RESULTS: Participating in Parkinson's Dance sessions meant that PwP could experience the possibilities to dance, develop a "can do" attitude, experience fun, enjoyment, social connection, exercise, movement to music, improvement and/or maintenance of their balance, suppleness, coordination and confidence with movement, symptoms being pushed back and ability to learn new things. CONCLUSIONS: Our findings add to the evidence-base about the benefits of dance for people experiencing Parkinson's and through novel application of the Life-world based well-being framework of K. T. Galvin and Todres (2011) we propose a theoretical basis for Parkinson's Dance as a resource for well-being. There is scope to consider application of the well-being framework to other arts activities and as the basis of an arts and well-being evaluation tool.

Communicative action, a path through the dissonance between nursing and corporate healthcare values.

There is tension in the US healthcare system due to conflicting goals of maximizing the public's health and at the same time ensuring shareholder profit among the many private organizations that provide care to those in need. As a result, nurses (often the frontline workers in this mixed public/private and economized system) may experience dissonance between their professional values and the capitalistic values embodied in the healthcare system. Beyond the workplace, nurses are also committed to championing health and wellness, to advocating for social justice, and driving health policy. Yet, constrained by the conflicts between neoliberal values in an economized system and the values of care that inspire many to join the healthcare profession, nurses may lose the ability to live up to their moral ideals, to champion social justice, and to improve public health outcomes. In this paper, we use the critical theory of Juergen Habermas to explore these tensions and to suggest a path forward for nurses. We suggest that by engaging in dialog with each other and the public, and working for greater inclusivity, nurses can find ways to deconstruct ideologies inherent in our current healthcare system, to consider alternatives, and liberate healthcare from the dominance of market forces.