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熊本大学学術リポジトリ Kumamoto University Repository System
熊本大学学術リポジトリ Kumamoto University Repository System Title 作業療法が医行為とされることに対する批判的考察 Author(s) 山野, 克明 Citation 先端倫理研究, 7: 29-47 Issue date 2013-03 Type Departmental Bulletin Paper URL http://hdl.handle.net/2298/27523 Right సᴗ⒪ἲࡀ་⾜Ⅽࡉࢀࡿࡇᑐࡍࡿᢈุⓗ⪃ᐹ ᒣ㔝 ඞ᫂ The critical consideration on the present status of occupational therapy being regarded as a medical practice Katsuaki Yamano Abstract The purpose of this study is to critically consider the present Japanese situation where occupational therapy is regarded as a medical practice. Occupational therapy which can be practiced only when the physicians write the prescription is treated as a relative medical practice in Japan. However, there have been a criticism on this point from the therapists and the other professions from 1970’s to 80’s. Then, the occupational therapists considered their therapy as a clinical practice different from medical practice by the new theories of occupational therapy that have been imported from the US and Canada to Japan since 1990’s. Occupational therapy which places a high value to the culture and the society for the patients and their community would not be regarded as a medical practice. Even so, the occupational therapists are not excluded from medical profession. Occupational therapists who practice in Japan may have absolute or relative occupational therapy practice which is different from medical practice, because they have had their own point of view which they have used the ͆occupation͇as a therapy for the patients. 0.ࡣࡌࡵ ᮏ✏ࡢ┠ⓗࡣࠊࢃࡀᅜࡢసᴗ⒪ἲࡀ་⾜Ⅽࡉࢀࡿࡇࡘ࠸࡚ᢈุⓗ⪃ᐹࡍࡿ ࡇ࠶ࡿࠋసᴗ⒪ἲኈࡣ 1965 ᖺไᐃࡉࢀࡓࠕ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲࠖ ࠾࠸࡚་⒪ࡢᑓ㛛⫋࡛࠶ࡿ⨨࡙ࡅࡽࢀ࡚࠸ࡿࠋࡓࡔࠊసᴗ⒪ἲኈࡣ་ᖌࡢᣦ♧ࡢ ୗసᴗ⒪ἲࢆ⾜࠺ࡇࡀつᐃࡉࢀ࡚࠸ࡿࠋࡇࡢἲᚊࢆ᰿ᣐࠊసᴗ⒪ἲࡣ་ᖌࡋ ⾜࠺ࡇࡢ࡛ࡁ࡞࠸་⾜Ⅽࡢ୍ࡘ࡛࠶ࡿゎ㔘ࡉࢀࡿࠋ ࡋࡋࠊᐇ㝿ࡢ⮫ᗋ࠾࠸࡚ࠊసᴗ⒪ἲኈࡣ⮬ࡽᝈ⪅ࡢ㞀ᐖࡢ⛬ᗘࢆᢕᥱࡋࠊసᴗ ⒪ἲィ⏬ࢆ❧ࡋࠊᝈ⪅┤᥋సᴗ⒪ἲࢆᐇ㊶ࡍࡿ❧ሙ࠶ࡿࠋసᴗ⒪ἲኈࡀసᴗ⒪ ἲࢆ⊂⮬ࡢ⪃࠼ᇶ࡙࠸࡚ධᡭẁࡋࠊᝈ⪅ࡢே㛫ⓗᶒྥࡗ࡚ᑟࡃࡇࡀ - 29 - ࡛ࡁࡿࡍࢀࡤࠊసᴗ⒪ἲࡣసᴗ⒪ἲኈࡀ⊂⮬ᛶࢆᣢࡗࡓ⾜Ⅽゝ࠺ࡇࡀ࡛ࡁࡿࠋ ゝ࠸࠼ࢀࡤࠊసᴗ⒪ἲࡣ་⾜Ⅽࡋ࡚་ᖌࡀᐇ㊶ࡍࡿࡶࡢ࡛ࡣ࡞࠸ゝ࠼ࡿࠋࡇࡢ ࡼ࠺⪃࠼ࡿࠕసᴗ⒪ἲࡀ་⾜Ⅽぢ࡞ࡉࢀࡿྰࠖࡘ࠸࡚⪃ᐹࡍࡿࡇࡣࠊ సᴗ⒪ἲࡢᑓ㛛㸦⫋㸧ᛶࢆ⪃࠼ࡿୖ࡛ࡶព⩏࠶ࡿࡶࡢ⪃࠼ࡿࠋ ࡇࡢ┠ⓗࢆᯝࡓࡍࡓࡵࠊࡲࡎࠊ་⾜Ⅽసᴗࡘ࠸࡚ᐃ⩏࡙ࡅࢆ⾜࠸ࠊ⌧⾜ࡢἲ ᚊ࠾࠸࡚సᴗ⒪ἲࡀ་⾜Ⅽぢ࡞ࡉࢀࡿࡇࡢ☜ㄆࢆ⾜࠺ࠋࡘࡂ་⾜Ⅽࡋ࡚ࡢ సᴗ⒪ἲࡢᏑᅾᑐࡍࡿసᴗ⒪ἲኈ⮬㌟ࡢᝎࡳࡸ⫋✀ࡽࡢᢈุࡘ࠸࡚ࠊṔྐⓗ ኚ㑄ࡢほⅬࡽ࿊♧ࡍࡿࠋࡑࡋ࡚ࠊㅖእᅜ࡛⪃࠼ࡔࡉࢀࡓసᴗ⒪ἲࡢ⌮ㄽࡸᏛၥࡀࠊ ࢃࡀᅜࡢసᴗ⒪ἲኈࡁ࡞ᙳ㡪ࢆ࠼ࠊࢃࡀᅜࡢసᴗ⒪ἲࡘ࠸࡚་⾜Ⅽࡣ␗࡞ ࡿࡶࡢ⪃࠼ࡿࡁࡗࡅ࡞ࡗࡓࡇࢆ⤂ࡍࡿࠋࡑࡢୖ࡛ࠊࡇࢀࡽࡢ⌮ㄽࢆྲྀࡾධ ࢀࡓసᴗ⒪ἲࡀ་⾜Ⅽゝ࠼ࡿࡢࡘ࠸࡚⪃ᐹࡍࡿࠋ᭱ᚋࠊసᴗ⒪ἲኈࡣࠕస ᴗࢆ⏝࠸࡚ᝈ⪅ධࡍࡿࠖ⊂⮬ᛶࡀ࠶ࡾࠊ་⾜Ⅽࡣ␗࡞ࡿసᴗ⒪ἲ⾜Ⅽࡢྍ⬟ᛶ ࡘ࠸࡚ゝཬࡍࡿࠋ 1㸬་⾜Ⅽసᴗ 1-1.་⾜Ⅽసᴗ⒪ἲ ࡲࡎࡣࠊࢃࡀᅜ࠾ࡅࡿ་⾜Ⅽసᴗ⒪ἲࡢ㛵ಀࡘ࠸࡚☜ㄆࡋ࡚࠾ࡁࡓ࠸ࠋస ᴗ⒪ἲኈࡣ་⒪ࡢᑓ㛛⫋ࡋ࡚⨨࡙ࡅࡽࢀ࡚࠸ࡿࠋࡑࡢ᰿ᣐࡣࠊ1965 ᖺ⾜ࡉࢀ ࡓ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲ➨୍᮲ࡢ᮲ᩥ࠶ࡿࠋ➨୍᮲࡛ࡣࠊ ࠕࡇࡢἲᚊࡣࠊ⌮Ꮫ ⒪ἲኈཬࡧసᴗ⒪ἲኈࡢ㈨᱁ࢆᐃࡵࡿࡶࠊࡑࡢᴗົࡀࠊ㐺ṇ㐠⏝ࡉࢀࡿࡼ࠺ つᚊࡋࠊࡶࡘ࡚་⒪ࡢᬑཬཬࡧྥୖᐤࡍࡿࡇࢆ┠ⓗࡍࡿࠖ㸯㸧᫂グࡉࢀ࡚ ࠸ࡿࠋࡇࡢ᮲ᩥ࠶ࡿࠕ་⒪ࡢᬑཬཬࡧྥୖᐤࡍࡿࡇࢆ┠ⓗࡍࡿࠖࡢᩥゝࡀࠊ సᴗ⒪ἲኈࢆ་⒪ࡢᑓ㛛⫋࡛࠶ࡿゎ㔘࡛ࡁࡿ᰿ᣐ࡞ࡿࠋ ࡘࡂ་⒪ࡢᐃ⩏ࡘ࠸࡚ࠊ་Ꮫ㎡㸦་Ꮫ᭩㝔ห㸧ࡼࢀࡤࠕ་ᖌ࠾ࡼࡧࡑࡢ ࡢ་⒪ᚑ⪅ࡀ་ᖌࡢᣦ♧ᇶ࡙࠸࡚⾜࠺ᝈ⪅ࡢࠊእയࡢデ᩿ࠊ⒪ࡢ┠ⓗ࡛ ⾜ࢃࢀࡿ་⾜Ⅽࡢ⥲⛠ࠖ᭩ࢀ࡚࠸ࡿࠋ་⾜Ⅽࡣࡇࢀࡲ࡛ࡢ⾜ᨻゎ㔘࠾ࡼࡧุ ࡽࠕ་ᖌࡢ་Ꮫⓗุ᩿ཬࡧᢏ⾡ࢆࡶࡗ࡚ࡍࡿࡢ࡛࡞ࡅࢀࡤேయ༴ᐖࢆཬࡰࡋࠊཪ ࡣ༴ᐖࢆཬࡰࡍ࠾ࡑࢀࡢ࠶ࡿ⾜Ⅽࠖᐃ⩏ࡍࡿࡢࡀᐃㄝ࡞ࡗ࡚࠸ࡿࡼ࠺࡛࠶ࡿ㸦ᵽ ཱྀ 2007, p.6㸧㸰㸧ࠋ་⾜Ⅽࡣ 1 ᅇ࡛ࡶ⥅⥆ࡍࡿពᛮࢆᣢࡗ࡚࠸ࢀࡤࠊࠕ་ᴗࠖࡋ ࡚ゎ㔘ࡉࢀࡿࠋࡑࡋ࡚ࠊࡇࡢࡇࡀ་ᖌἲ➨༑᮲ࠕ་ᖌ࡛࡞ࡅࢀࡤ་ᴗࢆ⾜ࡗ࡚ࡣ ࡞ࡽ࡞࠸ࠖࡢ᰿ᣐ࡞ࡗ࡚࠸ࡿࠋ సᴗ⒪ἲኈࡣ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲ➨᮲ࡢ 4 ࠾࠸࡚ࠊ ࠕ་ᖌࡢᣦ♧ࡢୗ సᴗ⒪ἲࢆ⾜࠺ࡇࢆᴗࡍࡿࠖグࡉࢀ࡚࠸ࡿࠋࡇࢀࡣసᴗ⒪ἲࡀἲᚊୖ࠾࠸࡚ デ⒪ࡢ⿵ຓ⾜Ⅽࡉࢀࠊデ⒪ࡢ⿵ຓ⾜Ⅽࢆᴗົ⊂༨ࡋ࡚࠸ࡿಖᖌຓ⏘ᖌ┳ㆤᖌἲࡢ እつᐃ㸱㸧࡛࠶ࡿࡇࡽὴ⏕ࡋ࡚࠸ࡿࠋཌ⏕┬ᖹᡂඖᖺᗘཌ⏕⛉Ꮫ◊✲ࠕ་⒪⾜Ⅽ ཬࡧ་⒪㛵ಀ⫋✀㛵ࡍࡿἲ་Ꮫⓗ◊✲ࠖሗ࿌᭩㸲㸧࡛ࡣࠊ་⾜Ⅽࢆ⤯ᑐⓗ་⾜Ⅽ┦ - 30 - ᑐⓗ་⾜Ⅽ༊ศࡋ࡚࠸ࡿࠋ⤯ᑐⓗ་⾜Ⅽࡣࠊ ࠕ་ᖌཪࡣṑ⛉་ᖌࡀᖖ⮬ࡽ⾜ࢃ࡞ ࡅࢀࡤ࡞ࡽ࡞࠸㧗ᗘ༴㝤࡞⾜Ⅽࠖࡢࡇ࡛࠶ࡿࠋᑐࡋ࡚┦ᑐⓗ་⾜Ⅽࡣ⤯ᑐ ⓗ་⾜Ⅽ௨እࡢ་⾜Ⅽ࡛ࠊ་ᖌࡀ་⒪ᚑ⪅ࡢ⬟ຊࢆ຺ࡋࡓୖ࡛ࠊ་ᖌࡢุ᩿ࡼ ࡗ࡚་⒪ᚑ⪅ࡑࡢ⾜ⅭᐇࡢྍྰࢆỴᐃࡍࡿࡶࡢ࡛࠶ࡿ㸦p.5㸧ࠋྠሗ࿌᭩࡛ࡣࠊ ་ᖌࡀ་⒪ᚑ⪅⾜࠺ᣦ♧ࡘ࠸࡚ࠊໟᣓⓗ⾜࠺ሙྜලయⓗ⾜࠺ሙྜࡀ࠶ࡿ グࡋ࡚࠸ࡿ㸦p.6㸧ࠋࡑࡢໟᣓⓗᣦ♧ࡼࡿ་⾜Ⅽࡢ୰⌮Ꮫ⒪ἲࡀྵࡲࢀ࡚࠸ࡿ 㸦p.8㸧ࠋసᴗ⒪ἲࡣࡇࡢ༊ศ᫂グࡉࢀ࡚࠸࡞࠸ࡀࠊ⌮Ꮫ⒪ἲసᴗ⒪ἲࡣᡤ⟶ࡉࢀ ࡿἲᚊࡀྠࡌࡶࡢ࡛࠶ࡿࡇࡽࠊ᪉ࡶ┦ᑐⓗ་⾜Ⅽྵࡲࢀࡿᛮࢃࢀࡿࠋ 1-2㸬సᴗࡣఱ ࡘࡂసᴗ⒪ἲࡢࡓࡿධᡭẁ࡛࠶ࡿసᴗࡢᐃ⩏ࡘ࠸࡚ㄝ᫂ࡍࡿࠋ1965 ᖺ ⾜ࡉࢀࡓ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲ➨᮲ࡢ㸰࠾࠸࡚ࠊ ࠕసᴗ⒪ἲࡣ㌟యཪࡣ⢭ ⚄㞀ᐖࡢ࠶ࡿ⪅ᑐࡋࠊࡋ࡚ࡑࡢᛂ⏝ⓗືస⬟ຊཪࡣ♫ⓗ㐺ᛂ⬟ຊࡢᅇࢆ ᅗࡿࡓࡵࠊᡭⱁࠊᕤసࡑࡢࡢసᴗࢆ⾜࡞ࢃࡏࡿࡇࢆ࠸࠺ࠖ 㸯㸧グࡉࢀ࡚࠸ࡿࠋࡓ ࡔࠊࡇࡢ᮲ᩥࡣࠊసᴗ⒪ἲኈࡀᝈ⪅ᑐࡋ࡚ࠕᡭᕤⱁࡔࡅࢆ⾜ࢃࡏ࡚࠸ࡿࠖ࠸࠺ព ࡛ࠊධᡭẁࡀᴟࡵ࡚㝈ᐃࡉࢀࡓ⒪ἲ࡛࠶ࡿ࠸࠺ゎ㔘ࡘ࡞ࡀࡿྍ⬟ᛶࢆ᭷ࡋ࡚ ࠸ࡓ㸳㸧ࠋࡑࡇ࡛ࠊᅜࡢసᴗ⒪ἲኈࡼࡗ࡚⤌⧊ࡉࢀࡓᑓ㛛⫋ᅋయ࡛࠶ࡿ♫ᅋἲே᪥ ᮏసᴗ⒪ἲኈ༠ࡣࡑࡢࡼ࠺సᴗࡀ೫ࡗࡓぢ᪉ࢆࡉࢀ࡚࠸ࡿ࠸࠺Ⅼࡽࠊ1986 ᖺ సᴗࢆࠕసᴗάືࠖ⛠ࡋࡓᙧ࡛సᴗ⒪ἲࢆୗグࡢࡼ࠺ᐃ⩏ࡋࡓࠋ సᴗ⒪ἲࡣࠊ㌟యཪࡣ⢭⚄㞀ᐖࡢ࠶ࡿ⪅ࡲࡓࡣࡑࢀࡀண ࡉࢀࡿ⪅ᑐࡋࠊࡑ ࡢయⓗ࡞⏕άࡢ⋓ᚓࢆᅗࡿࡓࡵࠊㅖᶵ⬟ࡢᅇࠊ⥔ᣢཬࡧ㛤Ⓨࢆಁࡍసᴗάືࢆ⏝ ࠸࡚ࠊ⒪ࠊᣦᑟཬࡧຓࢆ⾜࠺ࡇࢆ࠸࠺㸦᪥ᮏసᴗ⒪ἲኈ༠つ⣙ጤဨ 1986, p.69㸧 ࠋ ᪥ᮏసᴗ⒪ἲኈ༠ࡣసᴗ⒪ἲࡢ᭱⤊┠ᶆࢆࠕ㞀ᐖࡢ㍍ῶ࠶ࡿࡢ࡛ࡣ࡞ࡃࠊయ ⓗ࡞άືཧຍࢆຓࡍࡿࡇ࡛࠶ࡿࠖ 㸦♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠ 2012, p.12㸧 ᐃࡵ࡚࠸ࡿࠋࡑࡋ࡚ࠊࡑࡢ┠ᶆࢆᐇ⌧ࡍࡿࡓࡵసᴗ⒪ἲኈࡀ⏝࠸ࡿࠕసᴗάືࠖࢆ ࠕ᪥ᖖ⏕άࡢㅖືసࡸࠊ㐟ࡧ࡞ே㛫㛵ࢃࡿࡍ࡚ࡢㅖάືࠖ㸴㸧ᐃ⩏ࡋ࡚࠸ ࡿࠋ࡞࠾ࠊ᪥ᮏసᴗ⒪ἲኈ༠࡛ࡣసᴗ⒪ἲ࡛⏝࠸ࡽࢀࡿసᴗ㛵ࡋ࡚ࠊឤぬ࣭㐠ື άືࠊ⏕άάືࠊస࣭⾲⌧άືࠊ࣭Ꮫ⩦άືࡢ 4 ࡘศ㢮ࡋ࡚࠸ࡿ㸦⾲ 1㸧ࠋ - 31 - ⾲ సᴗάືࡢ 䞉≀⌮ⓗ䛺ឤぬ㐠ື่⃭㻌 ឤぬ䞉㐠ືάື㻌 䠄‽ഛάື䜢ྵ䜐䠅㻌 䞉䝤䝷䞁䝁䚸䜚ྎ䚸䝖䝷䞁䝫䝸䞁䚸䝇䜽䞊䝍䞊䝪䞊䝗䚸䝃䞁䝕䜱䞁䜾䞉䝪䞊䝗䚸㻌 㻌 䝥䝷䝇䝔䜱䝑䜽䝟䝔䚸䛭䛾䛾ឤぬ㐠ື㐟䜃㻌 䞉䝀䞊䝖䝪䞊䝹䚸㢼⯪䝞䝺䞊䚸䝎䞁䝇䚸య᧯䚸䛭䛾䛾㍍䝇䝫䞊䝒άື㻌 䞉䛭䛾㻌 䞉㣗䚸᭦⾰䚸ἥ䚸ධᾎ䚸ᩚᐜ䚸⾨⏕➼䛾䝉䝹䝣䜿䜰㻌 䞉㉳ᒃ䚸⛣ື䚸⛣䚸≀ရ䞉㐨ල䞉㐟ල䛾᧯స㻌 ⏕άάື㻌 䞉ᐙ䚸Ᏻ䚸㔠㖹䛾⮬ᕫ⟶⌮䜢ྵ䜐⏕ά⥔ᣢ⟶⌮άື㻌 䞉䝁䝭䝳䝙䜿䞊䝅䝵䞁㻌 䞉䛭䛾㻌 䞉㠉⣽ᕤ䚸ᮌᕤ䚸㝡ⱁ䚸⦅䜏≀䚸䝰䝄䜲䜽䚸⡢⣽ᕤ䚸䛿䜚⤮䛺䛹䛾ᡭᕤⱁ㻌 స䞉⾲⌧άື㻌 䠄‽ഛάື䜢ྵ䜐䠅㻌 䞉⤮⏬䚸㡢ᴦ䚸┿䚸᭩㐨䚸⏕䛡ⰼ䚸Ⲕ㐨䚸ತྃ䞉ᕝᰗ䛺䛹䛾ⱁ⾡άື㻌 䞉ᅖ◻䚸ᑗᲦ䚸䝨䜾䝪䞊䝗䚸カ⦎⏝䝥䝷䝇䝔䜱䝑䜽䝁䞊䞁➼䛾ྛ✀䝀䞊䝮㻌 䞉ⰼቭస䜚䚸⳯ᅬస䜚䛺䛹䛾ᅬⱁ㻌 䞉䛭䛾㻌 䞉᭩Ꮠ䚸ィ⟬䚸䝽䞊䝗䝥䝻䝉䝑䝃䚸䝁䞁䝢䝳䞊䝍㻌 䞉⏕άᅪᣑάື㻌 䞉Ꮫ⩦άື㻌 䞉ྛ✀♫㈨※䛾⏝㻌 䞉බඹ㏻ᶵ㛵䛾⏝䚸୍⯡㏻䛾⏝㻌 䞉䛭䛾㻌 㸦♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠Ꮫ⾡㒊 2006. p.14 ࢆ୍㒊ᨵኚ㸧 ࡇࡇ࡛ࠊᐇ㝿సᴗ⒪ἲኈࡀ⮫ᗋ࡛ࡢࡼ࠺࡞సᴗࢆ⏝࠸࡚࠸ࡿࡘ࠸࡚ᴫほࡍ ࡿࠋ ♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠ࡀⓎ⾜ࡋࡓࠗసᴗ⒪ἲⓑ᭩ 2010࠘ࡼࡿࠊ་⒪㡿ᇦ㸵㸧 ᚑࡍࡿసᴗ⒪ἲኈࡀ㌟య㞀ᐖ㸶㸧ࢆ᭷ࡍࡿ 65 ṓᮍ‶ࡢᝈ⪅ᑐࡋ࡚⏝࠸ࡿసᴗࡣࠊ ⏝࠸࡚࠸ࡿసᴗ⒪ἲኈࡢከ࠸㡰ᇶᮏືసカ⦎㸦89.2㸣㸧ࠊ᪥ᖖ⏕άάື㸦85.7㸣㸧ࠊ ࣭Ꮫ⩦άື㸦55.6㸣㸧 ࠊᡭᕤⱁ㸦48.8㸣㸧࡞ࡗ࡚࠸ࡿࠋࡲࡓࠊ65 ṓ௨ୖ࡛ࡣ᪥ ᖖ⏕άάື㸦93.3㸣㸧ࠊᇶᮏືసカ⦎㸦93.3㸣㸧ࠊᡭᕤⱁ㸦65.1㸣㸧ࡢ㡰࡞ࡗ࡚࠸ࡿࠋ ୍᪉ࠊ་⒪㡿ᇦ࡚ᚑࡍࡿసᴗ⒪ἲኈࡀ⢭⚄㞀ᐖ㸷㸧ࢆ᭷ࡍࡿᝈ⪅ᑐࡋ࡚సᴗ⒪ ἲኈࡀ⏝࠸ࡿάືࡣࠊ⏝࠸࡚࠸ࡿసᴗ⒪ἲኈࡢከ࠸㡰ᡭᕤⱁ㸦92.8㸣㸧ࠊస࣭ⱁ⾡ άື㸦91.2㸣㸧ࠊ㌟య㐠ືάື㸦85.4㸣㸧ࡢ㡰࡞ࡗ࡚࠸ࡿ㸦♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ ༠ 2012, p.34,44㸧ࠋ - 32 - 㸰㸬సᴗ⒪ἲࡣ་⾜Ⅽ㸽 2-1.సᴗ⒪ἲࡀ་⾜Ⅽぢ࡞ࡉࢀࡿࡇࡢㄽ⌮ సᴗࡀࠕ᪥ᖖ⏕άࡢㅖືసࡸࠊ㐟ࡧ࡞ே㛫㛵ࢃࡿࡍ࡚ࡢㅖάືࠖᐃ⩏ ࡙ࡅࡽࢀ࡚࠸ࡿࡢ࡛࠶ࢀࡤࠊ㢖ᗘᕪࡣ࠶ࡿࡶࡢࡢࠊࡑࡢ༙ࡣᡃࠎࡢᬑẁࡢ⏕άࡢ ୰࡛ᗣࡘ࠸࡚≉ู࡞ព㆑ࢆᣢࡘࡇ࡞ࡃ⾜ࢃࢀࡿࡶࡢ࡛࠶ࡿࠋࡑࡢάືࢆసᴗ⒪ ἲኈࡀᝈ⪅⏝࠸ࡿࡇ࡛ࠊࡑࡢάືࡣ་⾜Ⅽ࡞ࡗ࡚ࡋࡲ࠺ࡢ࡛࠶ࢁ࠺ࠋ ་⾜Ⅽࡀἲⓗ་⾜Ⅽぢ࡞ࡉࢀࡿࡓࡵࡣࠊ㸯㸧་Ꮫⓗ㐺ᛂࡢࡶ་ᖌࡀ⒪ ┠ⓗࢆ᭷ࡋ࡚࠸ࡿࠋ㸰㸧⏝࠸ࡽࢀࡿ་⒪⾜Ⅽࡢ᪉ἲࡀ⌧௦་⒪ࡢぢᆅࡽヨ࡚ጇᙜ࡞ ࡶࡢ࡛࠶ࡿࠋ㸱㸧ᝈ⪅ࡢྠពࡀ࠶ࡿࠋ࠸࠺㸱ࡘࡢ᮲௳ࡀᣲࡆࡽࢀ࡚࠸ࡿ㸦ᡭᔱ 2008㸪 pp.34-5㸧ࠋࡇࡢ࠺ࡕࠊ㸱㸧ࡘ࠸࡚➹⪅ࡣࡍ࡛సᴗ⒪ἲኈ⮬ࡽࡀᝈ⪅ࡽࣥࣇ࢛ ࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࢆᚓࡿࡇࡢ㔜せᛶࢆㄽࡌ࡚࠸ࡿ㸦ᒣ㔝 2010㸧ࠋࡋࡓࡀࡗ࡚ࠊࡇ ࡇ࡛ࡣ㸯㸧㸰㸧ࡘ࠸࡚⪃࠼࡚࠸ࡃࠋ 㸯㸧་Ꮫⓗ┠ᶆࡢࡶ་ᖌࡀ⒪┠ⓗࢆ᭷ࡋ࡚࠸ࡿ ἲⓗ᰿ᣐࢆࡶゝ࠼ࡤࠊసᴗ⒪ἲࡢ┠ⓗࡣ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲ➨㸰᮲ࡢ 㸰࠶ࡿࡼ࠺ࠕᛂ⏝ⓗືస⬟ຊཪࡣ♫ⓗ㐺ᛂ⬟ຊࡢᅇࠖ࠶ࡿࠋ୍᪉ࠊྠࡌἲ ᚊෆ࠾࠸࡚ᑓ㛛⫋ࡋ࡚⨨࡙ࡅࡽࢀ࡚࠸ࡿ⌮Ꮫ⒪ἲࡢ┠ⓗࡣࠕᇶᮏⓗືసࡢᅇࠖ ࡛࠶ࡿࠋࡇࡢἲᚊୖࡢ༊ูࢆࡶࠊከࡃࡢ་ᖌࡣࠕᇶᮏⓗືసࠖࢆ㉳ࡁࡿࠊ❧ࡘࠊ Ṍࡃ࠸ࡗࡓᇶᮏືసᐃ⩏ࡋࡓࠋ୍᪉ࠊ ࠕᛂ⏝ⓗືసࠖࡣ㣗ࠊ᭦⾰ࠊධᾎ࠸ࡗࡓ ᪥ᖖ⏕άάືࠊὙ℆ࡸᤲ㝖࠸ࡗࡓᡭẁⓗ᪥ᖖ⏕άάືࠊࡸࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥ ࡞ᖜᗈ࠸ࡶࡢࡋ࡚ᐃ⩏ࡋࡓࠋ ་ᖌసᴗ⒪ἲኈࡣࡶᛂ⏝ⓗືస⬟ຊࡢᨵၿసᴗ⒪ἲࡢ┠ⓗࡀ࠶ࡿ⪃࠼ࡓࠋ ࡑࡋ࡚ࠊᛂ⏝ⓗືసࡢ㐙⾜ࡀᅔ㞴࡞ࡿཎᅉࢆᝈᇶ࡙ࡃఱࡽࡢᚰ㌟ᶵ⬟ࡢపୗ 㸦ᶵ⬟㞀ᐖ㸧ᤊ࠼ࡓࠋࡑࡋ࡚ࠊࡑࡢᶵ⬟㞀ᐖࡢᨵၿࡢࡓࡵࠊ✀ࠎࡢసᴗࢆᡭẁࡋ ࡚⏝ࡋࠊ⤖ᯝࡋ࡚ᛂ⏝ⓗືసࡢᨵၿ⤖ࡧࡅࡼ࠺ࡍࡿࡶࡢ࡛࠶ࡗࡓࠋࡋࡓࡀ ࡗ࡚ࠊసᴗ⒪ἲࡣࠊ࠼ࡤ࠶ࡿࠕ⫋ᴗࡢᖐࠖࡶࡋࡃࡣ࠶ࡿࠕ᪥ᖖ⏕άάືࡢ⮬❧ࠖ ࢆ┠ᶆタᐃࡋࠊࡑࡢ┠ᶆ฿㐩ࡍࡿࡓࡵࡢ㌟యⓗࡶࡋࡃࡣ⢭⚄ⓗၥ㢟ࢆ⒪ࡍࡿ┠ ⓗࢆ᭷ࡋ࡚࠸ࡿࠋࡺ࠼సᴗ⒪ἲࡣ་⾜Ⅽぢ࡞ࡉࢀࡿ࠸࠺ࡇ࡞ࡿࠋ 㸰㸧⏝࠸ࡽࢀࡿ་⒪⾜Ⅽࡢ᪉ἲࡀ⌧௦་⒪ࡢぢᆅࡽぢ࡚ጇᙜ࡞ࡶࡢ࡛࠶ࡿ ࠾ࡑࡽࡃࠊ⌧௦་⒪࠾࠸࡚㔜どࡉࢀࡿࡶࡢࡣࠕ⛉Ꮫⓗ᰿ᣐ࡛ࠖ࠶ࢁ࠺ࠋ1990 ᖺ௦ Evidence based Medicine ࡢ㔜せᛶࡀୡ⏺ⓗ࡞ྜពࢆᚓ࡚ࡽࠊ་ᖌࡢ⒪ᡭẁࡢ 㑅ᢥ⫥ࡣࠊࡇࡢ Evidence based Medicine ጤࡡࡽࢀ࡚࠸ࡿ࠸ࡗ࡚ࡶ㐣ゝ࡛ࡣ࡞࠸ࠋ ࡓࡔࠊసᴗ⒪ἲࡀࡇࡢぢᆅࡽ་⾜Ⅽぢ࡞ࡉࢀࡿࡇࢆ☜ㄆࡋࡼ࠺ࡍࡿࠊసᴗ ⒪ἲࡢ⠊ᅖࡣ㠀ᖖ㝈ࡽࢀࡓࡶࡢ࡞ࡿࠋ ࠼ࡤࠊࢃࡀᅜ࡛సᴗ⒪ἲࡢ⛉Ꮫⓗ᰿ᣐࡘ࠸࡚㏙ࡿୖ࡛௦⾲ⓗ࡞ᣦ㔪ࡋ࡚ࠕ⬻ ༞୰⒪࢞ࢻࣛࣥࠖ10㸧ࡀ࠶ࡿࠋࡇࡢ୰࡛ࠊᅇᮇࣜࣁࣅࣜࢸ࣮ࢩ࡛ࣙࣥࡣసᴗ⒪ ἲࡢ㐺ᛂࢆุ᩿ࡋ࡞ࡀࡽࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ⾜࠺ࡇࡀ່ࡵࡽࢀࡿ࠸࠺ࡇࡘ - 33 - ࠸࡚ࠊᑡ࡞ࡃࡶ㸯ࡘ௨ୖࡢ↓సⅭẚ㍑ᑐ↷ヨ㦂◊✲ࢆྵࡴ⤖ᯝࡋ࡚ࠕ⾜࠺ࡼ࠺່ ࡵࡽࢀࡿࠖヱᙜࡍࡿࢢ࣮ࣞࢻ B ࡋ࡚⤂ࡉࢀ࡚࠸ࡿ 11㸧ࠋࡓࡔࠊసᴗ⒪ἲࡢ⒪ᡭ ẁ㛵ࡍࡿ⛉Ꮫⓗ᰿ᣐ࡛ࡣࠊ ࠕ㯞⑷ഃୖ⫥ᑐࡋࠊ≉ᐃࡢカ⦎㸦㯞⑷ഃୖ⫥ࡢ࣮ࣜࢳ㐠 ືࠊ࣓ࢺࣟࣀ࣮࣒ྜࢃࡏࡓ୧ୖ⫥ࡢ⧞ࡾ㏉ࡋ㐠ືࠊ┠ⓗᚿྥᆺ㐠ືࠊ࣓࣮ࢪカ⦎ ࡞㸧ࢆ✚ᴟⓗ⧞ࡾ㏉ࡋ⾜࠺ࡇࡀᙉࡃ່ࡵࡽࢀࡿࠖ 㸦ࢢ࣮ࣞࢻ A㸧ࠊ ࠕ㯞⑷ࡀ㍍ᗘࡢ ᝈ⪅ᑐࡋ࡚ࡣࠊ㐺ᛂࢆ㑅ࡤࠊ㠀㯞⑷ഃୖ⫥ࢆᢚไࡋࠊ⏕άࡢ୰࡛㯞⑷ഃୖ⫥ࢆᙉ ไ⏝ࡉࡏࡿ⒪ἲࡀ່ࡵࡽࢀࡿ㸦ࢢ࣮ࣞࢻ B㸧ࠖ࠶ࡿࠋࡇࡇ࡛ࠊ⾲ 1 ࡛♧ࡋࡓ୰ࡢ ࠕ≀⌮ⓗ࡞ឤぬ㐠ື่⃭ࠖ௨እࡢసᴗࡣฟ࡚ࡇ࡞࠸ࠋ సᴗ⒪ἲኈࡣࡇࢀࡽࡢ┠ᶆࡢ୰ࡽࡼࡾⰋ࠸ࡶࡢࢆ㑅ᢥࡍࡿࡓࡵࠊᝈ⪅ࡢ᪥ࠎࡢ ⏕άࡢ୰࡛㐙⾜ྍ⬟࡞㒊ศ㐙⾜ᅔ㞴࡞㒊ศࠊࡶࡋࡃࡣᐇ⾜ࡋ࡚࠸ࡿ㒊ศᐇ⾜ࡋ࡚ ࠸࡞࠸㒊ศࢆ☜ㄆࡍࡿࠋྠᝈ⪅ࡢ㛵⠇ྍືᇦࡸ➽ຊࠊ㧗ḟ⬻ᶵ⬟㞀ᐖࡢ᭷↓࠸ ࡗࡓᚰ㌟ᶵ⬟ࡢ⛬ᗘࢆ ᐃࡍࡿࠋࡑࡋ࡚ᝈ⪅ࡢ⏕άࡢ୰࡛ᝈ⪅ᮏேࡀᮃࢇ࡛࠸ࡿࡶ 㛵ࢃࡽࡎࠊᐇ⾜ྍ⬟ࡶࡋࡃࡣᐇ⾜ࡋ࡚࠸࡞࠸㒊ศᑐࡋ࡚ࠊࡑࡢཎᅉࢆᚰ㌟ᶵ⬟ ồࡵࡿࠋసᴗ⒪ἲኈࡣࡑࡢཎᅉࢆᢕᥱࡋࡓୖ࡛ࠊᝈ⪅ᮏேࡗ࡚ᮃࡲࡋ࠸ᛮࢃࢀ ࡿ⏕άࡢ≧ែࡶࡋࡃࡣࡑࡢⅬ࡛㐙⾜ᅔ㞴࡛࠶ࡿືసࡀᨵၿࡋࡓࠕ࠶ࡿ≧ែࠖࢆ┠ᶆ ࡋ࡚タᐃࡍࡿࠋࡑࡢୖ࡛ࠊసᴗ⒪ἲኈࡣࡑࡢ┠ᶆ฿㐩ࡍࡿࡓࡵᚲせ࡞సᴗࢆ㑅 ᢥࡋࠊࡇࢀࢆసᴗ⒪ἲࡢ⒪ᡭẁࡋ࡚⏝࠸ࡿࡢ࡛࠶ࡿࠋ 2-2.་⾜Ⅽࡋ࡚ࡢసᴗ⒪ἲᑐࡍࡿᢈุ ࡇࡢࡼ࠺࡞㐣⛬ࢆ⤒࡚సᴗࡀ⏝࠸ࡽࢀࡿࡍࢀࡤࠊ㑅ᢥࡉࢀࡓసᴗࡀࡓ࠼ࡤᅬⱁ ࡸࣃࢯࢥࣥ᧯స࡛࠶ࡿࡋ࡚ࡶࠊ་Ꮫⓗぢᆅᇶ࡙ࡃ┠ⓗࢆᣢࡗࡓᡭẁࡋ࡚་⾜Ⅽ ࡋ࡚ᢅࢃࢀ࡚ࡶ࠸࠸ࡢࡶࡋࢀ࡞࠸ࠋࡋࡋࠊ➹⪅ࡣ㸰ࡘࡢ⌮⏤ࡼࡾࡇࡢࡇࡣ ᢈุⓗᤊ࠼࡚࠸ࡿࠋ ࡑࡢ⌮⏤ࡢ୍ࡘࡣࠊ⌮Ꮫ⒪ἲࡢᕪ␗ࡢၥ㢟࡛࠶ࡿࠋ సᴗ⒪ἲࡀసᴗࢆ⏝࠸ࡿ࠸࠼ࡶࠊసᴗࢆ㑅ᢥࡍࡿᇶ‽࠾ࡼࡧసᴗࡢ┠ⓗࡢ༙ ࡣࠊࡑࡢసᴗࢆ㜼ᐖࡍࡿᚰ㌟ᶵ⬟⤖ࡧࡘ࠸࡚ࡋࡲ࠺ࠋ࠼ࡤࠊ࠶ࡿᝈࡼࡗ࡚ᡭ ᣦࡢ➽ຊࡀ㒊ศⓗపୗࡋࡓᝈ⪅ᑐࡋࠊఱࡽࡢసᴗࢆ⾜࠺ࡋ࡚ࡶࠊࡑࡢసᴗࡀ ➽ຊࡢᨵၿࢆ┠ⓗࡍࡿࡢ࡛࠶ࢀࡤࠊࡑࢀࡣ⌮Ꮫ⒪ἲࡀࡓࡿ⒪ᡭẁࡋ࡚⏝࠸ࡿ 㐠ື⒪ἲࡢ┠ⓗ㔜」ࡍࡿࠋࡲࡓࠊᐇ㝿ᝈ⪅ࡀ࡞ࢇࡽࡢ᪥ᖖ⏕άάືࡸ⫋ᴗᖐ ࢆ┠ⓗࡋ࡚ࡋ࡚ࡶࠊᡭᣦ࠶ࡿࡢ➽ຊࡀṇᖖ࡞➽ຊࢆಖࡗ࡚࠸ࡿሙྜࠊ㏻ᖖࡼ ࡾ㛫ࢆせࡍࡿྍ⬟ᛶࡣ࠶ࡿࡶࡢࡢࠊ௦ൾⓗ࡞㐠ືࢆࡗ࡚సᴗࢆ㐙ࡍࡿࡇࡀྍ ⬟࡛࠶ࡾ࠺ࡿࠋࡇࢀ࡞ࡽࡤࠊసᴗ⒪ἲࡢ┠ⓗࡣ⤖ᒁ㌟యᶵ⬟ྥࡅࡽࢀ࡚࠸ࡿࡢྠ ࡌ࡛࠶ࡿࠋసᴗࢆᚰ㌟ᶵ⬟ᨵၿࡢ፹ࡋ࡚⏝࠸ࡿ࡞ࡽࡤࠊ㐠ື⒪ἲࡢཎ⌮ࢆ⏝࠸࡞ ࡀࡽᚐᡭⓗᝈ⪅ࡢ➽ຊᨵၿࢆࡣࡿ᪉ࡀຠ⋡ⓗ࡛࠶ࡿࠋᜍࡽࡃࠊከࡃࡢసᴗ⒪ἲኈ ࡣࡇࡢࡼ࠺⪃࠼ࡿࡇࡀ࠶ࡿᛮ࠺ࠋࡑ࠺࡛࡞ࡅࢀࡤࠊ㌟య㞀ᐖࢆ᭷ࡍࡿᝈ⪅ᑐ ࡋ࡚సᴗ⒪ἲኈࡀ⏝࠸ࡿసᴗ⒪ἲᇶᮏືసカ⦎ࡀᣲࡀࡿࡇࡣ࡞࠸ࠋࡓࡔࠊᚋ㏙ࡍ ࡿࡀࠊࡇࢀࡽࡢసᴗࢆᝈ⪅ࡢ㌟యᶵ⬟⤖ࡧࡘࡅࡼ࠺ࡍࡿ⪃࠼᪉ࡣ㑏ඖ⩏ࡋ࡚ - 34 - సᴗ⒪ἲኈෆእࡽᢈุࡢᑐ㇟࡞ࡗࡓࠋࡑࡋ࡚ࠊసᴗ⒪ἲࡣ⌮Ꮫ⒪ἲࡋ࡚࠸ࡿ ᢈุࡉࢀࠊࡑࡢ⊂⮬ᛶࢆၥどࡉࢀࡓᮇࡀ࠶ࡗࡓࠋ ࡶ࠺୍ࡘࡣಶேࢆ୍ேࡢே㛫ࡋ࡚ぢ࡚࠸࡞࠸࠸࠺Ⅼ࡛࠶ࡿࠋ ඛ㏙ࡋࡓࡼ࠺ࠊసᴗࡢ┠ⓗࢆᝈ⪅ࡢᚰ㌟ᶵ⬟ྥࡅࡿ㝈ࡾࠊࡑࢀࡣ㝈ࡾ࡞ࡃ⏕≀ Ꮫⓗ࡞⾜೫ࡗ࡚ࡋࡲ࠺ࠋࡘࡲࡾࠊ➽ࡢ⦰ᵝᘧࡸ㛵⠇ࡢᵓ㐀ࢆᇶ┙࠾࠸ࡓࠊᝈ ⪅୍ேࡦࡾࡢಶᛶࡢ࡞࠸୍ᐃࡢἲ๎ᛶࢆࡶࡗࡓࡶࡢࡢぢ᪉࡞ࡗ࡚ࡋࡲ࠺ࠋࡇࡢሙ ྜࡢၥ㢟ࡣࡘ࠶ࡿࠋ୍ࡘࡣసᴗࡀᝈ⪅ࡢᚰ㌟ᶵ⬟⛬ᗘ࡛㑅ᢥࡉࢀࡿ࠸࠺ᙧ࡛⏬୍ ⓗ࡞ࡶࡢ࡞ࡗ࡚ࡋࡲ࠸ࡀࡕ࡞ࡾࠊᮏ᮶ከᵝ࡛࠶ࡿࡁᝈ⪅ᮏேࡢே⏕ᛂࡌࡓస ᴗࢆᥦ౪࡛ࡁࡿࡁࡗࡅࡀ⏕ࡲࢀ࡞࠸ࡇ࡛࠶ࡿࠋࡶ࠺୍ࡘࡣࠊ㔜ᗘࡢ㞀ᐖࢆ᭷ࡍࡿ ᝈ⪅ࠊ࠼ࡤࠊ㧗ࡢ㢕㧊ᦆയࡼࡗ࡚ᅄ⫥㯞⑷ࢆ᭷ࡍࡿᝈ⪅ࡸࠊ➽ⴎ⦰ᛶഃ⣴◳ ࡛ᅄ⫥ࡢືࡁࡀࡈࡃஈࡋ࠸ᝈ⪅࠾࠸࡚ࡣࠊᐇ⾜࡛ࡁࡿసᴗࡀ࡞࠸࠸࠺ࡇ࡞ ࡗ࡚ࡋࡲ࠺ࠋࡍ࡞ࢃࡕࠊࡇࢀࡽࡢᝈ⪅ᑐࡋࠕࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ㐺ᛂࡣ࡞࠸ࠖ⤖ ㄽࢆᑟࡁฟࡍ⤖ᯝ㝗ࡗ࡚ࡋࡲ࠺༴㝤ᛶࢆᏎࢇ࡛࠸ࡿࠋ 㸱㸬1980 ᖺ௦ࡲ࡛ࡢࠕ་⾜Ⅽࡋ࡚ࡢసᴗ⒪ἲࠖࡢᢈุⓗぢゎ 3-1.సᴗ⒪ἲኈࡢᅜᐙ㈨᱁௨๓࠾ࡅࡿᢈุⓗぢゎ ࡇࢀࡲ࡛ࡶ㏙࡚ࡁࡓࡼ࠺సᴗ⒪ἲኈࡣ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲࢆ᰿ᣐᣢ ࡘ་⒪ࡢᑓ㛛⫋ࡋ࡚ࡢᅜᐙ㈨᱁࡛࠶ࡿࠋἲⓗ་⒪⫋ࡋ࡚ࡢᏑᅾࡀᢸಖࡉࢀ࡚࠸ ࡿ௨ୖࠊ⮬ࡽࡀᝈ⪅⏝࠸ࡿసᴗ⒪ἲࡀ་⾜Ⅽぢ࡞ࡉࢀࡿࡇᛕࢆᣢࡘࡇࡣ ࡞࠸ࡢࡶࡋࢀ࡞࠸ࠋࡋࡋࠊసᴗ⒪ἲࡀ་⾜Ⅽぢ࡞ࡉࢀࡿࡇࡘ࠸࡚ᛕࢆᣢ ࡘ⪅ࡣ࡞ࡾ௨๓ࡽᏑᅾࡋࡓࠋ ᡓ୰ᡓᚋࡅ࡚⤖᰾ᝈ⪅ࡢデ⒪࠶ࡓࡗࡓෆ⛉་࡛࠶ࡿ㘐ᖹࡣࠊᙜࡢ་ᖌࡓ ࡕࡽࠕసᴗ⒪ἲࡣ⒪ἲ࡛࠶ࡿࠖ࠸࠺ၥࡀ⥆ฟࡋ࡚࠸ࡿࡇࢆグࡋ࡚࠸ࡿ㸦 1947㸪p.256㸧ࠋࡑࡢᛕᑐࡋࠊࡣ⤖᰾ࡢ⒵ࡣ⌮Ꮫⓗ⒵࡛ࡣ࡞ࡃ♫ⓗ ⒵࡛࠶ࡾࠊ་ᖌࡢၥࡣࡇࡢ♫ⓗ⒵ࢆ⒪ࡋ࡚ㄆ㆑ࡋ࡞࠸ࡓࡵ⏕ࡎࡿࡶࡢ࡛ ࠶ࡿᅇ⟅ࡋ࡚࠸ࡿ㸦 1947㸪p.256㸧ࠋࡑࡋ࡚ࠊ⫵⤖᰾ᝈ⪅ᑐࡍࡿసᴗ⒪ἲࡣ⒪ ࡢ᭱⤊ẁ㝵࡛♫ⓗព⩏ࡀ࠶ࡿࡀࠊࡇࡢ♫ⓗ㠃ࡢᙉㄪ༑ศ࡞་Ꮫⓗ࡙ࡅࢆᚲせ ࡍࡿᙇࡋ࡚࠸ࡿ㸦 1947, pp.256-8㸧ࠋࡑࡋ࡚ࠊࡣసᴗ⒪ἲࡘ࠸࡚ࠕ་Ꮫ ⓗࡣ㈇Ⲵヨ㦂࡛࠶ࡿࠖ㸦 1947, p.264㸧12㸧࠸࠺ぢゎࢆ♧ࡋ࡚࠸ࡿࠋ ࡣ་ᖌ࡛࠶ࡾ⮬ࡽసᴗ⒪ἲࢆᐇ㊶ࡋ࡚࠸ࡿ❧ሙ࡛࠶ࡗࡓࠋࡣ⌮Ꮫⓗ࡞ᝈ࠾ ࡼࡧ㌟యᶵ⬟ࡢపୗࡔࡅ࡛ࡣ࡞ࡃࠊᝈ⪅ࡢ♫⏕άࢆᵓ⠏ࡍࡿࡓࡵࡢධࡶ་⒪࡛ ࠶ࡿ࠸࠺ព࡛ࠊ⮬ࡽᐇ㊶ࡍࡿసᴗ⒪ἲࢆ་⾜Ⅽࡋ࡚ᤊ࠼࡚࠸ࡓᛮࢃࢀࡿࠋ 3-2㸬సᴗ⒪ἲኈࡢᅜᐙ㈨᱁ᚋ࠾ࡅࡿᢈุⓗぢゎ సᴗ⒪ἲኈࡢἲไᚋ 10 ᖺࡀ⤒㐣ࡋࡓ 1975 ᖺࡣࠊ➨ 9 ᅇ᪥ᮏసᴗ⒪ἲᏛ࠾ ࠸࡚ࠊࢩ࣏ࣥࢪ࣒࢘ࠕ⚾ࡢ⪃࠼ࡿ OTࠖࡀ㛤ദࡉࢀࡓࠋࡇࡢ୰࡛ࢩ࣏ࣥࢪࢫࢺࡋ࡚Ⓩ ቭࡋࡓసᴗ⒪ἲኈ 4 ྡຓゝ⪅ࡋ࡚Ⓩቭࡋࡓ་ᖌࡀࠕసᴗ⒪ἲࡀ་⒪࡛࠶ࡿྰࠖ - 35 - ࠸࠺ほⅬࡽⓎゝࢆࡋ࡚࠸ࡿࠋࡇࡢ࡞࡛ 4 ྡࡢసᴗ⒪ἲኈࡣࠊ᪥ࠎࡢ⮫ᗋࡢ୰࡛ ࡢ⮬ࡽࡢᝎࡳࡸ⫋✀ࡽཷࡅ࡚ࡁࡓᢈุࢆࡶࠊసᴗ⒪ἲኈࡀゎỴࡍࡁㄢ㢟ࢆ Ⓨゝࡋ࡚࠸ࡿࠋ 㙊▴Ꮚࡣ⡿ᅜ࡛ࡣ moral treatment㸦㐨ᚨ⒪ἲ㸧ࡽసᴗࢆ⒪⏝ࡍࡿᙧ࡛ Ⓨᒎࡋ࡚ࡁࡓࡇࢆ㏙࡚࠸ࡿࠋࡑࡋ࡚ࠊࢃࡀᅜࡢసᴗ⒪ἲࡀ་⒪࡛࠶ࡿࡓࡵࡣ᭷ ຠᛶᬑ㐢ᛶࡀ㔜せ࡛࠶ࡿࡇࢆ㏙࡚࠸ࡿࠋࡇࡢ࡞࡛ࠊసᴗ⒪ἲࡢṔྐ㊊ࡋ ࡚࠸ࡓࡶࡢࡋ࡚ࠕලయⓗᐇࡢ᳨ドࠖࢆᙉㄪࡋࠊసᴗ⒪ἲࡀ⒪࡛࠶ࡿࡇࡢㄢ 㢟ࢆᣲࡆ࡚࠸ࡿ㸦㙊 1991, pp.4-5㸧ࠋ బ⸨๛ࡣ㐣ཤ 10 ᖺࡢసᴗ⒪ἲࡢⓎᒎࡀᚲࡎࡋࡶᝈ⪅ᑐࡋ་Ꮫࡽ♫ᚰ⌮ཬࡧ ⫋ᴗⓗ⮬❧ࡢᶫΏࡋᙺ࡞ࡗ࡚ࡁࡓၥ࡛࠶ࡿ㏙࡚࠸ࡿࠋࡑࡋ࡚ࠊసᴗ⒪ἲ ࡀ་⒪࡛࠶ࡿࠊ࠶ࡿ࠸ࡣࡑࢀࡼࡾ㞳ࢀࡓ♫ⓗᚰ⌮ⓗ᪉ྥᛶࢆᣢࡘࡁࠊᚋ᳨ ウࡋ࡚࠸࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࡇࢆᙇࡋ࡚࠸ࡿ㸦㙊 1991, pp.6-7㸧ࠋ 㕥ᮌ᫂Ꮚࡣసᴗ⒪ἲࡀࠕࡑࡢேࡢ♫ⓗࠊ㌟యⓗࠊᚰ⌮ⓗࠕ③ࡳࠖࡢ㍍ῶࡍࡿ㐣⛬ࠖ ࡛࠶ࡿ㏙࡚࠸ࡿࠋࡑࡢୖ࡛㕥ᮌࡣࠊ ࠕࡑࡢ③ࡳࢆࡇࡲ࡛ඹឤ࡛ࡁࡿ࠸࠺῝ࡉ ࡣே㛫㛵ࡍࡿࡇࡀከ࠸ࠖࡇࢆᣦࡋ࡚࠸ࡿࠋࡑࡋ࡚ࠊࠕࠕసᴗ⒪ἲࡣࢡࣛ ࣥࢺࡢၥ㢟ゎỴࡢ┦ㄯࡢࡿࡇࠖࡶゝ࠼ࡿࠖ⤖ㄽ࡙ࡅ࡚࠸ࡿ㸦㙊 1991, p.10㸧 ࠋ ᑎᒣஂ⨾Ꮚࡣసᴗ⒪ἲኈࡀ⌮Ꮫ⒪ἲኈẚࠕ་⒪⾜Ⅽࠖࡋ࡚ࡢᤊ࠼᪉ࡀᕼⷧ࡞ ࡇ࡛࠶ࡿⅬࢆᣦࡋ࡚࠸ࡿࠋࡑࡋ࡚ࠊసᴗ⒪ἲኈࡀࡲࡎ་⒪ࡋ࡚⮫ᗋⓗࡶไᗘ ⓗࡶ☜❧ࡍࡿࡇࡀඛỴ࡛࠶ࡿࡇࢆᙇࡋ࡚࠸ࡿ㸦㙊 1991, pp.11-2㸧ࠋ ࡇࢀࡽ 4 ྡࡢసᴗ⒪ἲኈࡓࡕࡢⓎゝࢆ㋃ࡲ࠼࡚ࠊຓゝ⪅ࡋ࡚Ⓩቭࡋࡓ་ᖌࡢ୰ࠊ సᴗ⒪ἲࡢ⌧≧ᑐࡍࡿᢈุࢆ⾜࠺⪅ࡀ࠸ࡓࠋࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་Ꮫᑓ㛛་ࡢⲶᓥ ⚽⏨ࡣࠊ๓ 20 ྡࡢ་ᖌᑐࡋ࡚ࠕᝈ⪅ࡢ⒪ࢆᏳᚰࡋ࡚సᴗ⒪ἲኈ౫㢗ࡋ࡚࠾ ࡽࢀࡲࡍࠖ࠸࠺㉁ၥࢆ⾜࠸ࠊࡑࡢ࠺ࡕ 19 ྡࡀ͆No͇ᅇ⟅ࡋࡓ⤖ᯝࢆሗ࿌ࡋ࡚ ࠸ࡿࠋࡑࡋ࡚ࠊࡑࡢ⌮⏤ࡋ࡚ࠊ ࠕ་Ꮫⓗ▱㆑ࡀ㊊ࡾ࡞࠸ࠖࠊ ࠕ࢚࣮ࣜࢺព㆑ࡀᙉࡍࡂࡿࠖ ࠸࠺ᅇ⟅ࡀ࠶ࡗࡓࡇࢆ㏙࡚࠸ࡿࠋࡇࡢⅬࢆ㋃ࡲ࠼ࡓୖ࡛ࠊⲶᓥࡣసᴗ⒪ἲኈ ᑐࡋࠕ᪂ࡋ࠸ศ㔝ཝࡋࡉࡀᚲせ࡛࠶ࡿࡢࠊసᴗ⒪ἲኈ࡛ࡣࡑࡢཝࡋࡉࡀ࡞࠸ ࠸࠺ࡇࡣ⫋✀ࡢᑗ᮶ᛶࢆ༴࠺ࡃࡍࡿࠖࡇࢆ㆙࿌ࡋ࡚࠸ࡿ㸦㙊 1991, p.16㸧ࠋ ࡲࡓࠊ⢭⚄⛉་ᖌ࡛࠶ࡿ᰿ᓊṇᡂࡣࠕసᴗ⒪ἲࡀ་⒪ゝࢃࢀࡿࡶࡢ࠺࠸ ࡗࡓၥࢆᣢࡓࡊࡿࢆᚓ࡞ࡗࡓࠖసᴗ⒪ἲࡀ་⒪࡛࠶ࡿࡇၥࡢኌࢆᢞࡆ ࡅ࡚࠸ࡿࠋࡑࡋ࡚ࠊ ࠕ୍㈏ࡋࡓࣉࣟࢢ࣒ࣛࡀ࠶ࢀࡤ་⒪༑ศཧ࡛ࡁࡿࡇࠖࢆᣦ ࡋ࡚࠸ࡿࠋࡑࡢୖ࡛ࠊ ࠕసᴗ⒪ἲኈࡢᝈ⪅ࡢࢃࡾࡘ࠸࡚ࡣᙜ↛⒪ⓗⰍᙬࢆᣢ ࡓ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠖࠊసᴗ⒪ἲࡀ་⒪࡛࠶ࡿࡇࢆᙉㄪࡋ࡚࠸ࡿ㸦㙊 1991, pp.19-20㸧ࠋ ࡇࡢࢩ࣏ࣥࢪ࣒࢘ࡽ 10 ᖺᚋࡢ 1986 ᖺ㛤ദࡉࢀࡓ➨ 20 ᅇ᪥ᮏసᴗ⒪ἲᏛ࡛ ࡣࢩ࣏ࣥࢪ࣒࢘ࠕసᴗ⒪ἲ㸫ࡑࡢ᰾ࢆၥ࠺ࠖࡀ㛤ദࡉࢀࡿࠋࢩ࣏ࣥࢪࢫࢺࡢ᪨ࡣࠕస - 36 - ᴗ⒪ἲࡣఱࠖࡘ࠸୍࡚ᐃࡢྜពࢆᚓࡓ࠸࠸࠺ࡶࡢ࡛࠶ࡗࡓࠋࡋࡋࠊྖࢆ ົࡵࡓ▮㇂௧Ꮚࡣసᴗ⒪ἲኈࡢἲไ 20 ᖺࢆ⤒࡚ࠊసᴗ⒪ἲኈᑐࡍࡿཝࡋ࠸ᢈุࡀ ࠶ࡿࡇࢆᣦࡋ࡚࠸ࡿࠋࡑࡢᢈุࡢෆᐜࡣࠕసᴗ⒪ἲࡢຠᯝุᐃࡀ࡞ࡃࠊ㞀ᐖホ ౯ࡢ☜❧ࡶ࡞࠸ࠖࠊࠕ⮬ศࡓࡕࡔࡅ࡛‶㊊ࡋ࡚࠸ࡿ㞟ᅋࠊ࿘ᅖࡸ♫ࡢࢽ࣮ࢬࡣ↓㡻 ╔࡛࠸ࢃࡤᏊࡶࡢ㞟ᅋࠖ࠸࠺ࡶࡢ࡛࠶ࡗࡓ㸦▮㇂ 1986㸪p.263㸧ࠋ ࡲࡓࠊࡇࡇ࡛ࢩ࣏ࣥࢪࢫࢺࡋ࡚Ⓨゝࡋࡓ་ᖌࡢ༤⏣⠇ኵࡣసᴗ⒪ἲࢆࠕ་⒪ࢫࢱࢵ ࣇࡗ࡚㠀ᖖ⌮ゎࡋࡀࡓ࠸⒪ἲࡢ୍ࡘࠖᢈุࡋࡓࠋࡑࡢ⌮⏤ࡣࠕ⒪ᡭẁࡀ ⒪ࡣࡃ↓㛵ಀ࡞ࡗ࡚࠸ࡿࠖࠊࠕ⫋✀ᑐࡋ࡚⒪ⓗព⩏ࢆ⛉Ꮫⓗㄝ࡛᫂ࡁ ࡞࠸ࠖ࠸ࡗࡓࡶࡢ࡛࠶ࡗࡓ㸦༤⏣ 1986㸪p.267㸧ࠋ సᴗ⒪ἲኈࡀᡃࡀᅜㄌ⏕ࡋ࡚㛫ࡶ࡞࠸ᮇ࡛ࡢసᴗ⒪ἲኈࡢⓎゝࡣࠊ ࠕࡲࡔⱝ࠸⫋ ✀࡛࠶ࡾᅵྎ࡞ࡿᏛၥࡶᐇࡋ࡚࠸࡞࠸≧ἣࡢ୰࡛ࠊ⮬ศࡓࡕࡀࡇྥ࠾࠺ ࡋ࡚࠸ࡿࡢࠖ࠸࠺ヨ⾜㘒ㄗࡢ≧ែ࡛࠶ࡿࡇࢆఛ࠺ࡇࡀ࡛ࡁࡿࠋࡓࡔࠊ་ᖌ ࡽࡢᣦ࠶ࡿࡼ࠺సᴗ⒪ἲࡢຠᯝࡢ᳨ドࡸ⛉Ꮫᛶࡘ࠸࡚ࡣࠊసᴗ⒪ἲࡀ་⒪࡛ ࠶ࡿࡓࡵࡢ⏕⥺࡛࠶ࡿ࠸࠺୍ᛂࡢㄆ㆑ࡀ࠶ࡗࡓࡶࡢ⪃࠼ࡿࠋ ࡇࡢ 1970 ᖺ௦ࡽ 1980 ᖺ௦ࡅ࡚ࠊసᴗ⒪ἲኈࡣ⮬ศࡓࡕࡢࢹࣥࢸࢸ ་⒪ࡋ࡚ࡢ❧ሙ⛉Ꮫᛶࡢ㏣ồࢆồࡵ࡚࠸ࡓᮇ࡛࠶ࡗࡓ㸦㛗㇂ 2001㸪pp.47-8㸪 51-3ࠊ㔝⸨ 2003㸪pp.12-3㸧ࠋࡾࢃࡅసᴗ⒪ἲኈࡀᝈ⪅ࡢ㌟య┤᥋ゐࢀࠊືⓗ ᝈ⪅ࡢ㌟యࢆືࡋ࡞ࡀࡽṇᖖ࡞㐠ືࢆᘬࡁࡔࡍࡇ࡛㐠ື㞀ᐖࡢᅇࢆಁ㐍ࡍࡿ ࠸࠺ࠊ࠸ࢃࡺࡿࣇࢩࣜࢸ࣮ࢩࣙࣥࢸࢡࢽࢵࢡࡣከࡃࡢసᴗ⒪ἲኈཷࡅධࢀࡽࢀࡓࠋ ࣇࢩࣜࢸ࣮ࢩࣙࣥࢸࢡࢽࢵࢡࡣゎ๗Ꮫࠊ⏕⌮Ꮫࠊ㐠ືᏛࠊ⚄⤒Ꮫ࠸ࡗࡓ་Ꮫ⣔ࡢ Ꮫၥࢆᇶ┙ࡋࡓᙧ࡛ᐈほᛶࡸ⌧ᛶࢆ᫂☜࡛ࡁࠊࡉࡽ⇍⦎ࡋࡓᢏ⾡ࢆࡶ࡚ࡤࠊ ᝈ⪅ᑐࡋⓗ࡞ຠᯝࢆ࠼ࡿࡇࡀ࡛ࡁࡿࡉࢀࡓࡽ࡛࠶ࡿࠋࡋࡋࠊࡇࡢࣇ ࢩࣜࢸ࣮ࢩࣙࣥࢸࢡࢽࢵࢡࡣ༙ࡀ་ᖌࡶࡋࡃࡣ⌮Ꮫ⒪ἲኈࡼࡗ࡚㛤Ⓨࡉࢀࡓࡶࡢ ࡛࠶ࡗࡓࠋࡑࡢࡓࡵࠊࡇࡢᢏ⾡ࢆ⏝࠸ࡿసᴗ⒪ἲࡣ⌮Ꮫ⒪ἲࡢᕪ␗ࢆ⾲⌧ࡍࡿࡇ ࡀᅔ㞴࡞ࡗࡓࠋࡇࡢࡇࡼࡾࠊసᴗ⒪ἲኈࡣ⫋✀ࡽཝࡋ࠸ᢈุࡉࡽࡉࢀࡿࠋ ࡾࢃࡅࠊ༤⏣ྠࡌࡃࢩ࣏ࣥࢪࢫࢺࡋ࡚Ⓩቭࡋࡓ⌮Ꮫ⒪ἲኈࡢ⏣ཱྀ㡰ᏊࡣࠕPT ࡲ ࡀ࠸ࡢ OT ࢆࡸࡿࡢ࡛ࡣ㸦୰␎㸧PT ࡢ㔜ㄳồཷࡅྲྀࡽࢀ࡚ࡶ⮴ࡋ᪉ࡢ࡞࠸ࡇ࡛ ࡍࠖ⌮Ꮫ⒪ἲࡉࢀࡘࡘ࠶ࡿసᴗ⒪ἲࡢ⌧≧ࢆ③Ⅿᢈุࡋࡓ㸦⏣ཱྀ 1986㸪p.270㸧ࠋ ࡇࡇࡲ࡛ࡢ⤒⦋࡛ࠊࡶࡋసᴗ⒪ἲኈࡀࣇࢩࣜࢸ࣮ࢩࣙࣥࢸࢡࢽࢵࢡࢆ⏝ࡋ⥆ࡅ ࡿࡢ࡛࠶ࢀࡤࠊࠕసᴗ⒪ἲࡣ་⾜Ⅽࠖ࠸࠺ၥ࠸ᑐࡍࡿᅇ⟅ࡣ Yes ࡞ࡿࡔࢁ࠺ࠋ ࡋࡋࠊࡑࡢࡼ࠺ᅇ⟅ࡋ࡚ࡋࡲ࠺ࠊసᴗ⒪ἲኈࡀ་⒪ࡢᑓ㛛⫋࡛࠶ࡿ࠸࠺❧ሙ ࡣ୍ᛂᢸಖࡉࢀࡿࡀࠊ⌮Ꮫ⒪ἲࡢᕪ␗ࡀ࡞࠸ࡲࡲ࡞ࡗ࡚ࡋࡲ࠸ࠊసᴗ⒪ἲኈࡢᑓ 㛛ᛶࡣ࡞࠸࠸࠺⤖ㄽࢆᑟ࠸࡚ࡋࡲ࠺ࠋ - 37 - 㸲㸬་⾜Ⅽࡣ␗࡞ࡿసᴗ⒪ἲ⌮ㄽ 4-1.సᴗ⒪ἲ⌮ㄽࡢ⤂ సᴗ⒪ἲኈࡣ⮬ศࡓࡕࡢᑓ㛛ᛶࡀࡇ࠶ࡿࢆ⪃࠼࡞ࡅࢀࡤ࡞ࡽ࡞ࡗࡓࠋࡇࡢ ࡇ୍ᛂࡢྜពࢆ‶ࡓࡍ⤖ㄽࡣࠊ1960 ᖺ௦௨㝆ࡢ⡿ᅜ࠾ࡼࡧ࢝ࢼࢲ࠾࠸࡚Ⓨ⾲ࡉ ࢀࠊࡃ 1990 ᖺ௦ᡃࡀᅜ⛣ධࡉࢀࡓసᴗ⒪ἲ⌮ㄽ࠶ࡿᛮࢃࢀࡿࠋࡇࡇ࡛ࠊ ࡑࡢ⌮ㄽࢆ⡆༢࡛ࡣ࠶ࡿࡀ⤂ࡍࡿࠋ 4-1-1.సᴗ㐙⾜⌮ㄽ సᴗ㐙⾜⌮ㄽࡣ⡿ᅜ༡࢝ࣜࣇ࢛ࣝࢽᏛࡢసᴗ⒪ἲኈ Mary Reilly ࡀ 1962 ᖺึ ࡵ࡚බ⾲ࡋࡓ⌮ㄽ࡛࠶ࡿࠋᙜࡢ⡿ᅜࡢసᴗ⒪ἲኈࡣ⒪ࡋ࡚ࡢసᴗ⒪ἲࡢ⛉Ꮫᛶ ࢆᢈุࡍࡿ་ᖌࡓࡕࡽࡢᙉ࠸ᅽຊࢆཷࡅ࡚࠸ࡓࡼ࠺࡛࠶ࡿࠋࡑࡢࡓࡵࠊసᴗ⒪ἲኈ ࡣసᴗࡢ౯್ࢆసᴗࡑࡢࡶࡢ࡛ࡣ࡞ࡃࠊసᴗࢆ⾜࠺㐣⛬ࡢ୰࡛ࡢ㌟యࡢືࡁࡸᑐே 㛵ಀぢฟࡍࡼ࠺࡞ࡗ࡚࠸ࡓࠋࡑࡇ࡛ࡢࡓࡿᏛၥⓗᇶ┙ࡣ㐠ືᏛࠊ⚄⤒Ꮫࠊ⢭⚄ ศᯒᏛ࡛࠶ࡗࡓࠋసᴗ⒪ἲࡣ⒪ࡋ࡚ࡢ⛉Ꮫᛶࢆヲࡋࡃㄝ᫂ࡍࡿࡇࡀ࡛࠶ࡿ ࠸࠺㑏ඖ⩏ࡀ㊅ໃࢆ༨ࡵ࡚࠸ࡓࠋ㸦ᒣ⏣ 1982㸧ࠋ Reilly ࡣసᴗ⾜ື⌮ㄽࢆ⪃࠼ࡿ࠶ࡓࡾࠊ᪂ࡓ࡞సᴗ⒪ἲࡢᇶᮏࡋ࡚ே㛫ࢆᐃ ⩏ࡍࡿࡓࡵࠊゎ๗Ꮫࡸ⚄⤒⛉Ꮫ࡞ࡢ་Ꮫ࡛ࡣ࡞ࡃே㢮Ꮫࠊᚰ⌮Ꮫࠊ♫Ꮫࢆྵࡵ ࡿࡋࡓ㸦Reilly ᒣ⏣ヂ 1996, p.62㸧 ࠋࡑࡋ࡚ࠊReilly ࡣసᴗ⾜ື⌮ㄽࡢᯟ⤌ࡳࡋ࡚ 㸱ࡘࡢⅬࢆ⪃࠼ࡓࠋ➨ 1 ࡣసᴗ⒪ἲࡣே㛫ࡢࠕ㐩ᡂࡋࡓ࠸ࠖ࠸࠺Ẽᣢࡕ࡛࠶ࡿࠋ ➨ 2 ࡣ㐩ᡂࢆᐇ⌧ࡍࡿᡭẁࡋ࡚ࠕ㐟ࡧࠖࡀ㔜せ࡛࠶ࡿࡋࡓࠋࡑࡋ࡚ࠊ➨ 3 ࡣಶேࡢᙺࢆ㔜どࡋࡓ㸦Reilly ᒣ⏣ヂ 1996, p.61㸧ࠋReilly ࡣே㛫ࡢ⾜ືࢆ⪃࠼ࡿ Bertalanffy ࡀᥦၐࡋࡓ୍⯡ࢩࢫࢸ࣒⌮ㄽࢆ⫼ᬒࡋࠊࡑࡢ୰࡛ࡶ⎔ቃே㛫ࡢ ┦ὶ࠸࠺㛤ᨺࢩࢫࢸ࣒╔┠ࡋࡓࠋࡑࡋ࡚ࠊసᴗ⾜ື⌮ㄽ࡛ࡣࠊே㛫ࡀࡑࡢ⎔ ቃࡢኚᛂࡌ࡚ᩥࢆ㏻ࡋ࡚Ꮫ⩦ࡋࠊ㐺ᛂࡍࡿ㝿ࡢࠊ㐟ࡧࠊఇ᠁ࠊ╧╀࡞ࡢ ᪥ᖖ⏕άࡢࣃࢱ࣮ࣥࢆ㔜どࡋࡓ㸦Reilly ᒣ⏣ヂ 1996, p.58㸧ࠋ 4-1-2.ே㛫సᴗࣔࢹࣝ ே㛫సᴗࣔࢹࣝࡣ⡿ᅜ༡࢝ࣜࣇ࢛ࣝࢽᏛࡢసᴗ⒪ἲኈ Gary Kielhofner ࡼࡗ ࡚ 1985 ᖺึࡵ࡚බ⾲ࡉࢀࡓࠋKielhofner ࡣ Reilly ࡢసᴗ㐙⾜⌮ㄽࢆᘬࡁ⥅ࡂࠊⓎ ᒎࡍࡿᙧ࡛ࣦ࢙ࣝࢱࣛࣥࣇࡢ㛤ᨺࢩࢫࢸ࣒ὀ┠ࡋࡓࠋ ே㛫సᴗࣔࢹ࡛ࣝࡣࠊసᴗ⒪ἲኈࡣࢡ࢚ࣛࣥࢺࡢಶᛶὀ┠ࡍࡿࠋసᴗ⒪ἲኈࡣࢡ ࢚ࣛࣥࢺࡢ౯್ࠊ⬟ຊឤຠຊឤࠊᙺࠊ⩦័ࠊ⤒㦂ࠊಶேⓗ⎔ቃࢆ⌮ゎࡋᑛ㔜ࡋ ᨭࡍࡿࠋࡑࡋ࡚ࢡ࢚ࣛࣥࢺࡢ㑅ᢥࠊ⾜Ⅽࠊ⤒㦂ࡀసᴗ⒪ἲࡢ୰ᚰ࡛࠶ࡿࡍࡿ 㸦Kielhofner ᒣ⏣ヂ 2011a, p.4㸧Kielhofner ࡣே㛫ࢆ࣭᪥ᖖ⏕άάື࣭㐟ࡧࢆ㍈ ࡍࡿసᴗࢆồࡵࡿືᶵࡋ࡚ࡢࠕពᚿࠖࠊ᪥ࠎࡢ⏕άࢆࣃࢱ࣮ࣥࡍࡿࠕ⩦័ࠖࠊ ほⓗ⤒㦂ࢆᇶࡋࡓ≀ࢆ⾜࠺ࡓࡵࡢ⬟ຊ࡛࠶ࡿࠕ㐙⾜ᶵ⬟ࠖ࠸࠺ 3 ࡘࡢᵓᡂせ ⣲ࡽᡂࡿࡍࡿ㸦Kielhofner ᒣ⏣ヂ 2011b㸪p.12㸧 ࠋࢡ࢚ࣛࣥࢺᏑᅾࡍࡿ 3 ࡘ ࡢᵓᡂせ⣲ࡣ≀⌮ⓗ࣭♫ⓗ⎔ቃࡢ୰࡛࠸㛵ಀࡋ࡞ࡀࡽࠊࢡ࢚ࣛࣥࢺࢆసᴗࡢ - 38 - 㐺ᛂᑟࡇ࠺ࡍࡿࡶࡢ࡛࠶ࡗࡓ㸦Kielhofner ᒣ⏣ヂ 2011c㸪p.112-9㸧ࠋ 4-1-3.࢝ࢼࢲసᴗ㐙⾜ࣔࢹࣝ ࢝ࢼࢲసᴗ⒪ἲ༠ࡣࠊ1990 ᖺᚰ⌮Ꮫ⪅ Carl Rogers ࡼࡗ࡚ᥦၐࡉࢀࡓࢡࣛ ࢚ࣥࢺ୰ᚰ⒪ἲࢆᇶ┙࠾࠸ࡓࠕࢡ࢚ࣛࣥࢺ୰ᚰࡢసᴗ⒪ἲࠖࢆබ⾲ࡋࡓࠋࡇࡢࢡ ࢚ࣛࣥࢺ୰ᚰࡢసᴗ⒪ἲࡣ࢝ࢼࢲ࠾ࡅࡿసᴗ⒪ἲࡢ⮫ᗋᐇ㊶࢞ࢻࣛࣥࡋ࡚ බ⾲ࡉࢀࡓࠋ Townsend Polatajiko ࡼࢀࡤࠊసᴗ⒪ἲࡢᇶᮏ๓ᥦࢆࠕᇶᮏࢽ࣮ࢬࡋ࡚ࡢస ᴗࢆ⾜࠺ࡇࠖࠕసᴗࡀ₯ᅾⓗ⒪ⓗ౯್ࢆࡶࡘࠖࡇ࠾ࡃ㸦Polatajiko et al㸪 ྜྷᕝヂ 2010㸪p.43㸧ࠋసᴗࢆࡑࡢே≉᭷ࡢࡶࡢᤊ࠼ࠊಶேࡣᩥⓗࠊไᗘⓗࠊ≀⌮ ⓗࠊ♫ⓗ⎔ቃ࡛⏕άࡋ࡚࠸ࡿࡇ࡛సᴗࡢ⠊ᅖࢆ᫂ࡽࡍࡿࠋసᴗࡣே⎔ቃࢆ ࡘ࡞ࡂࠊಶேࡣసᴗࢆ㏻ࡋ࡚⎔ቃ࡛⏕άࡍࡿ 㸦Polatajiko et al㸪ྜྷᕝヂ 2011㸪pp.44-7㸧ࠋ ࡇࡢࡼ࠺࡞ᙧ࡛ࢡ࢚ࣛࣥࢺࡗ࡚ពࡢ࠶ࡿసᴗࢆ᥈ࡋฟࡋࠊࡑࡢసᴗࡢྍ⬟ 㸦enabling occupation㸧ྥࡗ࡚ാࡁࡅࡼ࠺ࡍࡿࠋ 4-1-4.సᴗ⛉Ꮫ 1989 ᖺ⡿ᅜ༡࢝ࣜࣇ࢛ࣝࢽᏛࡀసᴗ⒪ἲᏛࡢ༤ኈㄢ⛬ࢆタ⨨ࡍࡿ࠶ࡓࡾࠊ ᪂ࡋࡃጞࡲࡗࡓᏛၥ࡛࠶ࡿ㸦Zemke࣭Clark బ⸨ヂ 1999 p.xiii㸧ࠋ సᴗ⛉Ꮫ࡛ࡣ⒪ࡋ࡚ࡢసᴗ⒪ἲࢆ⪃࠼ࡿࡢ࡛ࡣ࡞ࡃࠊసᴗࡑࡢࡶࡢ↔Ⅼࢆᙜ ࡚ࡿࡍࡿࠋసᴗ⛉Ꮫࡣࠕసᴗ⒪ἲᐇ㊶ࢆࡢࡼ࠺⾜࠺ࢆ┤᥋ᑟࡃࡶࡢ࡛ࡣ࡞ࡃࠊ సᴗࡢ▱㆑ࢆయ⣔ⓗ✚ࡍࡿࡇࢆ┠ⓗࡋࡓᏛၥ㡿ᇦࠖ 㸦ྜྷᕝ 2008,p.7㸧ࡢ୍ࡘ ⪃࠼ࡿࠋసᴗ⛉Ꮫ࡛ࡣࠊసᴗࡢᙧࠊᶵ⬟ࠊពࢆ◊✲ࡍࡿ㸦ྜྷᕝ 2008,p.8㸧ࠋసᴗࡢᙧ ࡛ࡣࠊ ࠕసᴗࡀࡢࡼ࠺ほᐹࡉࢀࡿࡢࠊసᴗࡣࡢࡼ࠺࡞ࡲࡲࡾࡋ࡚Ꮡᅾࡍࡿ ࡢࠖࢆ⪃࠼ࡿࠋసᴗࡢᶵ⬟࡛ࡣࠕసᴗࢆࡍࡿࡇࡀࡢࡼ࠺ᙺ❧ࡘࡢࢆ⪃࠼ ࡿࠋࡑࡋ࡚ࠊసᴗࡢព࡛ࡣࠕసᴗࢆ⾜࠺ேࡗ࡚ࡢពࠊసᴗࡀ⾜ࢃࢀࡿᩥࡢ ୰࡛ࡢពࠊసᴗࡢ⤖ᯝࡀṧࡍṔྐⓗ࡞ពࢆ⪃࠼ࡿࠖࡍࡿ㸦ྜྷᕝ 2008, p.8㸧ࠋ 4-2㸬ࢃࡀᅜࡢసᴗ⒪ἲኈࡢᙳ㡪 ࡇࢀࡽࡢ⌮ㄽࡣ 1980 ᖺ௦ࡽ 90 ᖺ௦ࡅ࡚᪥ᮏ⛣ධࡉࢀࡓࠋࡇࢀࡽࡢ⌮ㄽࡣ ࢃࡀᅜࡢసᴗ⒪ἲኈࡁ࡞ᙳ㡪ࢆ࠼ࡓࠋࡑࡢ᭱ࡓࡿࡶࡢࡀࠊࡇࢀࡽࡢసᴗ⒪ἲ⊂ ⮬ࡢ⌮ㄽࡶࡋࡃࡣᏛၥࡉࢀࡿࡶࡢࡀ་Ꮫࡣ␗࡞ࡿࡶࡢࡋ࡚ᢅࢃࢀࡓࡇࡔࢁ࠺ࠋ సᴗ⒪ἲኈ࡛࠶ࡿᐑ๓⌔Ꮚࡣ Comte ࡀ࠺ࡕฟࡋࡓࠕ༢⣧࡞ࡶࡢࡽ」㞧࡞ࡶࡢࠖ ࠸࠺Ꮫၥᗎิࡢ Checkland ࡼࡿᨵᐃ∧ࢆ་Ꮫࠊ┳ㆤࠊ⌮Ꮫ⒪ἲࠊసᴗ⒪ἲࡢ୰᰾ 㡿ᇦࢆ࠶࡚ࡣࡵ࡚ẚ㍑ࡋࡓ㸦ᐑ๓ 2002㸧ࠋࡑࡋ࡚ࠊࠕసᴗ⒪ἲࡣ♫㸭ᩥࠊᚰ⌮ࠊ ⏕≀࠸ࡗࡓほⅬࡽసᴗࢆࡽ࠼ࠊ ࠕேࠖᗣᐤࡍࡿ࠸࠺ࡇ࡛࠶ࡾࠊ㐠ືᏛࠊ 㐠ື⏕⌮ᏛࠊᏛࠊ≀⌮ᏛほⅬࡽゎỴࡋࡼ࠺ࡍࡿ་Ꮫࡸ⌮Ꮫ⒪ἲࡣ⏕≀Ꮫࡢࣞ ࡛࣋ࣝࡋ㔜࡞ࡽ࡞࠸ࠖ 㸦ᐑ๓ 2002, p.515㸧㏙ࠊసᴗ⒪ἲኈࡣ་ᖌࡸ⌮Ꮫ⒪ἲ ኈࡣ᫂ࡽ㐪࠺⊂⮬ᛶࡀᏑᅾࡍࡿࡇࢆᙉㄪࡋࡓࠋࡲࡓࠊసᴗ⒪ἲኈ࡛࠶ࡿྜྷᕝ ࡦࢁࡳࡣࠊసᴗࡢ࠸᪉ࡋ࡚ࠕసᴗࡢຠ⏝ࡣࠊ⸆ࡢࡼ࠺ᝈࡸ≧ูࣜࢫࢺ - 39 - ࢵࣉ࡛ࡁ࡞࠸㸦୰␎㸧సᴗࡢຠ⏝ࡀ⸆␗࡞ࡿⅬࡣࠊ≧ࡸ㞀ᐖࡢኚ࠸࠺ࡼࡾࡶࠊ ᮏேࡗ࡚ពࡢ࠶ࡿసᴗࡢ㐙⾜ୖ⌧ࢀࡿኚ࡛࠶ࡿࠖ(ྜྷᕝ 2005, p.1165) ᙇࡋࡓࠋࡇࢀࡽࡢㄽ⪃௦⾲ࡉࢀࡿࡼ࠺ࠊసᴗ⒪ἲኈࡣᩥࡸ♫࠸ࡗࡓே㛫ࢆ ྲྀࡾᕳࡃ⎔ቃࢆษࡋ࡞ࡀࡽࠊࡑࡢேಶேࡗ࡚ពࡢ࠶ࡿసᴗࢆ㑅ᢥࡍࡿࡇ ࡀ࠸࠸⪃࠼ࡓࠋ 4-3㸬1990 ᖺ௦௨㝆ࡢࠕసᴗࠖࡢᐃ⩏ ๓⠇࡛ࡣࢃࡀᅜࡢసᴗ⒪ἲኈࡀ 1980 ᖺ௦௨㝆እᅜࡽධࡗ࡚ࡁࡓ་⾜Ⅽࡣ␗࡞ ࡿసᴗ⒪ἲ⌮ㄽࡸᏛၥࡁ࡞ᙳ㡪ࢆཷࡅࡓࡇࢆ㏙ࡓࠋࡇࡢ⌮ㄽࡢᬑཬࢆཷࡅ࡚ࠊ ᾏእ࡛ࡣసᴗ⒪ἲኈࡀ⏝࠸ࡿసᴗࢆᐃ⩏ࡋࡼ࠺ࡍࡿືࡁࡀຍ㏿ࡋ࡚ࡁࡓࠋ ࢝ࢼࢲసᴗ⒪ἲኈ༠ࡣ 1997 ᖺసᴗࢆḟࡢࡼ࠺ᐃ⩏ࡋࡓ సᴗࡣࠊ᪥ࠎ⏕ά࡛⾜ࢃࢀྡ࡙ࡅࡽࢀ࡚࠸ࡿ୍⩌ࡢάືࡸㄢ㢟࡛ࠊಶேᩥ ࡼࡾࠊࡑࡢ౯್ពࡀࡉࢀࡓࡶࡢࢆ࠸࠺ࠋసᴗࡣࠊ⮬ศࡢ㌟ࡢᅇࡾࡢࡇࢆ ⮬ศ࡛⾜࠺ࢭࣝࣇࢣࠊ⏕άࢆᴦࡋࡴࣞࢪ࣮ࣕࠊ♫ⓗࠊ⤒῭ⓗάື㈉⊩ࡍࡿ⏕⏘ άື࡞ࠊேࡀ⾜࠺ࡍ࡚ࡢႠࡳࡢࡇ࡛࠶ࡿ㸦Polatajiko et al㸪ྜྷᕝヂ 2011㸪p.38㸧ࠋ ࡲࡓࠊసᴗ⒪ἲኈࡢᅜ㝿ⓗ࡞ᑓ㛛⫋ᅋయ࡛࠶ࡿୡ⏺సᴗ⒪ἲ㐃┕ࡣ 2002 ᖺసᴗ ࢆࠕேࡀ⮬ศࡢᩥ࡛ពࡀ࠶ࡿ⾜࠺ࡇࡢࡍ࡚ࠖᐃ⩏ࡋ࡚࠸ࡿ㸦ྜྷᕝ 2008, p.10㸧 ࠋࡇࢀࡽࡢᐃ⩏ࡣࠕᩥࠖ࠸࠺ゝⴥࡀྵࡲࢀ࡚࠸ࡿࡀࠊࡇࡢどⅬࡣࡢ⫋✀ ࡣぢࡽࢀ࡞࠸సᴗ⒪ἲኈࡢ⊂⮬ᛶࢆໝࢃࡏࡿゝⴥ࡛࠶ࡿࠋ ྜྷᕝࡣ࢝ࢼࢲసᴗ⒪ἲኈ༠ࡀࠕసᴗࠖࡢᐃ⩏ࢆ 2002 ᖺ⡿ᅜసᴗ⒪ἲ༠ࡀࡑ ࡢࡲࡲᘬ⏝ࡋࡓࡇࢆᣦࡋࡓࠋࡑࡋ࡚ࠊࡇࡢࡇࡽࠕసᴗࠖࡢᐃ⩏ࡢ㆟ㄽࡀ᮰ ྥ࠺ࡇࢆணឤࡋ࡚࠸ࡿ㸦ྜྷᕝ 2005㸪p.1161㸧ࠋ 4-4.᪥ᮏࡢᩥࢆ⪃៖ࡋࡓసᴗ⒪ἲ ࡇࢀࡲ࡛ࠊᮏ❶࠾࠸࡚㏙࡚ࡁࡓసᴗ⒪ἲ⌮ㄽ࡞ࡽࡧࠕసᴗࠖࡢᐃ⩏ࡣࠊࢃࡀ ᅜࡢసᴗ⒪ἲኈᚎࠎ࡛ࡣ࠶ࡿࡀᾐ㏱ࡍࡿࡼ࠺࡞ࡗࡓࠋసᴗ⒪ἲࡢᑓ㛛ㄅ࡛࠶ࡿ ࠗసᴗ⒪ἲࢪ࣮ࣕࢼࣝ࠘2012 ᖺ 9 ᭶ྕ࡛ࡣࠊࠕࡢసᴗ⒪ἲࠖ࠸࠺≉㞟ࡀ⤌ࡲࢀ࡚ ࠸ࡓࠋࡇࡇ࡛ࡣࠊ2014 ᖺࢃࡀᅜ࡛ୡ⏺సᴗ⒪ἲ㐃┕Ꮫࡀ㛤ദࡉࢀࡿࡇࡀỴᐃࡋ ࡚࠸ࡿࡇࢆᛕ㢌᪥ᮏᩥ᰿ᕪࡋࡓసᴗࢆᩚ⌮ࡋࡓ࠸ࡍࡿ᪨ࡀ᭩ࢀ࡚࠸ࡿࠋ ࡑࡋ࡚ࠊ᪥ᮏࡢᩥࡸ⏕άసᴗ⒪ἲࡢ㛵㐃ࢆᴫほࡋࡓ࠸࠸࠺ᮇᚅࡀ㎸ࡵࡽࢀ࡚ ࠸ࡿ㸦ᐑᓮ 2012㸪p.1249㸧ࠋ సᴗ⒪ἲኈ࡛࠶ࡿᒣ᰿ᐶࡣࠊṇ᭶ࠊ᱈ࡢ⠇ྃࠊ༑ኪࠊᙼᓊ࠸ࡗࡓᅄᏘᢡࠎ࡛ࡢ ⾜ࡸࠊ⾜ࡲࡘࢃࡿヰࢆᝈ⪅⮬↛ྲྀࡾධࢀࡿࡇࡀࠊᝈ⪅ࡢ⒪㣴⏕άࢆព ࠶ࡿࡶࡢࡍࡿᣦࡋ࡚࠸ࡿࠋࡑࡋ࡚ࠊࡇࡢࡇࡀࡶࡓࡽࡍ⏕ࡁࡿពḧࡢᅇࡸ యⓗ࡞ྲྀࡾ⤌ࡳࡢຊࡣࡁ࠸㏙࡚࠸ࡿ㸦ᒣ᰿ 2012㸧ࠋࡲࡓసᴗ⒪ἲኈ࡛࠶ࡿᒾᓮ Ύ㝯ࡣࠊ᪥ᮏᩥࡢ≉ᚩࡋ࡚ࠊ␗ᅜࡢᩥࡸᩥ≀ࢆ✚ᴟⓗྲྀࡾධࢀࠊࡑࢀࡽࢆ ࠸ࡸࡍࡃኚࡉࡏࡿⅬࠊಶయࡢㄪࢆࡣࡿࣂࣛࣥࢫឤぬࠊࡇࡢࣂࣛࣥࢫࡽ ὴ⏕ࡍࡿ㓄៖ྜ⌮ᛶࠊࡶࡢࡢ࠶ࢃࢀ↓ᖖほࡢ㸲Ⅼࢆྲྀࡾୖࡆ࡚࠸ࡿ㸦ᒾᓮ 2012㸧ࠋ - 40 - ࡇࡢ㸲ࡘࡢ≉ᚩࢆⰍ⃰ࡃᫎࡋ࡚࠸ࡿసᴗࡋ࡚ࠊⲔ㐨ࠊ⳹㐨ࠊ᭩㐨ࠊᗙ⚙ࠊࡦ࡞ࡲ ࡘࡾࠊኤࠊ⠇ྃࠊ⋵ලࡢ㸶ࡘࢆᣲࡆ࡚࠸ࡿࠋࡇࡢᒣ᰿ᒾᓮࡀྲྀࡾୖࡆࡓసᴗࢆ⏝ ࠸ࡿసᴗ⒪ἲࡣ་⾜Ⅽ࡛࠶ࢁ࠺ࠋ 5.ࠕࡢసᴗ⒪ἲࠖࡀ་⾜Ⅽぢ࡞ࡉࢀࡿࡇࡢᢈุⓗぢゎ 5-1㸬་ᖌࡢฎ᪉ୖࡢၥ㢟Ⅼ ๓㡯࡛ᣲࡆࡓࠕࡢసᴗ⒪ἲࡘ࠸᳨࡚ࠖウࡍࡿࠊᑡ࡞ࡃࡶ་ᖌࡣࡇࢀࡽࡢస ᴗ㛵ࡍࡿฎ᪉ࢆฟࡍࡇࡀᅔ㞴ᛮࢃࢀࡿࠋసᴗ⒪ἲࢆᏲഛ⠊ᅖࡍࡿࣜࣁࣅࣜࢸ ࣮ࢩࣙࣥ་Ꮫࡢฎ᪉㡯┠ࡋ࡚ࡣࠊ୍⯡ⓗ㸯㸬ᶵ⬟ⓗసᴗ⒪ἲ㸦ྍືᇦᨵၿࠊ➽ຊ ቑᙉࠊ༠ㄪᛶᨵၿ㸧ࠊ㸰㸬᪥ᖖ⏕άάື࣭⏕ά㛵㐃ືసカ⦎ࠊ㸱㸬⮬ຓල࣭ࢫࣉࣜࣥࢺ ࡢస〇╔ࠊ㸲㸬⩏ᡭࡢ╔࣭᧯సカ⦎ࠊ㸳㸬ᄟୗᶵ⬟カ⦎ࠊ㸴㸬ᣦ♧ⓗ㸦ᚰ⌮ⓗ㸧 సᴗ⒪ἲࠊ㸵㸬ࣞࢡ࢚࣮ࣜࢩࣙࣥ⒪ἲࠊ㸶㸬⫋ᴗ๓カ⦎ࠊ10㸬ᐙᒇᨵ㐀ᣦᑟࡀᣲࡆࡽ ࢀ࡚࠸ࡿ㸦ᳺཎ 2009 p.539㸧ࠋ☜ࠊ་ᖌࡣฎ᪉ࡘ࠸࡚సᴗ⒪ἲࡢ┠ⓗࢆグ㍕ࡍ ࡿࡇࡀⰋࡃࠊලయⓗ࡞✀┠ࡣసᴗ⒪ἲ୍௵ࡍࡿࡇࡀⰋ࠸ࡉࢀ࡚࠸ࡿ㸦ᳺཎ 2009 p.539㸧ࠋࡋࡋࠊసᴗ⒪ἲ࡛ࡣసᴗࡑࡢࡶࡢពࡀ࠶ࡿゎ㔘ࡍࡿࠋ࠼ࡤ ࠕࡦ࡞ࡲࡘࡾࠖࢆࡋ࡚ఱᚰ㌟ࡢᶵ⬟ࡀᨵၿࡍࡿ⪃࠼ࡿࡢ࡛ࡣ࡞ࡃࠊࠕࡦ࡞ࡲࡘࡾࠖ ࡑࡢࡶࡢࡀᝈ⪅ࡗ࡚ពࡀ࠶ࡿ⪃࠼ࡿࡢ࡛࠶ࡿࠋ་ᖌࡀฎ᪉㡯┠ᥖࡆࡓࡶࡢ ࡣసᴗࢆูࡢ┠ⓗࢆᯝࡓࡍࡓࡵࡢ፹ࡍࡿࡇࡋ࡛ࡁ࡞࠸ࠋసᴗࡑࡢࡶࡢࡀᣢࡘ ࡀᝈ⪅ࡗ࡚ࡢ౯್ࢆᢕᥱࡋࠊసᴗ⒪ἲࡘ࡞ࡆࡿࡇࡣసᴗ⒪ἲኈࡋ࡛ࡁ࡞ ࠸࠸࠺ࡢࡀసᴗ⒪ἲኈࡢゝ࠸ศ࡛࠶ࡿࠋ 5-2.་⾜Ⅽࡢ㐣ゎ㔘 ࡋࡋࠊࡑࢀ࡛ࡶ་ᖌࡣࠕసᴗ⒪ἲࡣ་⾜Ⅽ࡛࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠖㄽࡍࡿࡔࢁ ࠺ࠋసᴗ⒪ἲࡢᑐ㇟࡞ࡿᝈ⪅ࡢከࡃࡣࠊཎᝈࡲࡓࡣྜేࡶࡋࡃࡣ᪤ Ṕࡼࡗ ࡚ఱࡽࡢࣜࢫࢡࢆ᭷ࡋ࡚࠸ࡿࠋࡇࡢሙྜࠊᝈ⪅ࡀ㝔ࡶࡋࡃࡣ⮬Ꮿ࠾࠸࡚せᮃࡍ ࡿసᴗࢆ㐙⾜ࡍࡿࡇࡼࡗ࡚ࠊᝈ⪅⮬㌟ࡢᚰ㌟ࡀఱࡽࡢ༴㝤ࡉࡽࡉࢀࡿࡶࡋ ࢀ࡞࠸࠸࠺ྍ⬟ᛶࡀྰᐃ࡛ࡁ࡞࠸ࠋࡼࡗ࡚ࠊࡑࡢࣜࢫࢡࡢ⛬ᗘࢆࡼࡃྫྷࡋ࡞ࡀࡽ ⾜ࡢ㐺ྰࢆỴᐃࡋ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋࡑࡢỴᐃᶒࡣ་ᖌ࡛࠶ࡿ࠸࠺ᙇ࡛࠶ࡿࠋ ࡓࡋࠊධ㝔୰ࡢᝈ⪅ࡀ࠶ࡿసᴗࢆ㐙⾜ࡋ࡚࠸ࡿ᭱୰Ṛஸࡋ࡞࠸࠸࠺☜ドࡣ࡞ ࠸ࠋࡇࡢⅬࡣ་⒪࠾ࡅࡿࢢ࣮ࣞࢰ࣮࡛ࣥ࠶ࡿࠋࢢ࣮ࣞࢰ࣮ࣥࡀྰᐃ࡛ࡁ࡞࠸㝈ࡾࠊ ࠕసᴗ⒪ἲࡀ་⾜Ⅽぢ࡞ࡉࢀࡿࠖࡇࡣྰᐃ࡛ࡁ࡞࠸࠸࠺ᙇ࡛࠶ࡿࠋ ࡋࡋࠊࡇࡢᙇࡣၥ㢟ࡀ࠶ࡿࠋࡇࢀࡲ࡛ࡢ་⒪ࡣࡇࡢࢢ࣮ࣞࢰ࣮ࣥࢆࡍ࡚་ ⒪ࡢ୰ྲྀࡾ㎸ࢇ࡛ࡁࡓࠋᵽཱྀࡶ་⾜Ⅽࡢゎ㔘ࡘ࠸࡚ࠕᑡࡋ࡛ࡶேయᦆയࢆ࠼ ࡑ࠺࡞⾜Ⅽࡣࡍ࡚ᢳ㇟ⓗ༴㝤࠶ࡾࡉࢀ࡚ࡁࡓࠖࡇࢆ㏙࡚࠸ࡿ㸦ᵽཱྀ 2007㸪 p.6㸧 ࠋࡋࡓࡀࡗ࡚ࠊ㝔ࡢ୰࡛ᝈ⪅ࡢᚰ㌟ᙳ㡪ࢆཬࡰࡍࡇࡣࡍ࡚་⾜Ⅽࡢ୍㒊 ࡔゎ㔘ࡉࢀ࡚ࡁࡓࠋ⤖ᯝࡋ࡚ࠊ࠼ࡤᝈ⪅㌿ಽࡢᜍࢀࡀࡃ࡞࠸ࡇࢆ☜ಙ࡛ ࡁ࡞࠸ࡢ࡛࠶ࢀࡤࠊᝈ⪅ࡀᅄᏘࡢ⾜ࢆᇳࡾ⾜࠺ࡓࡵṌ࠸࡚⛣ືࡍࡿࡓࡵࡣࠊࡑ - 41 - ࡢ⛣ືࡢྍྰࡘ࠸࡚་ᖌࡢุ᩿ࡀᚲせ࡛࠶ࡿ࠸࠺ゎ㔘࡞ࡗ࡚ࡋࡲ࠺ࠋࡇࢀࡣ་ ⾜Ⅽࡢ㐣ゎ㔘࡛࠶ࡿ⪃࠼ࡿࠋࡇࡢሙྜࠊ་⾜Ⅽࡢゎ㔘࡛ࡶࡗࡶไ㝈ࢆཷࡅࡿࡢ ࡣᝈ⪅࡛࠶ࡿࠋࡇࡢࡓࡵᝈ⪅ࡢάື㔞ࡀᢚไࡉࢀࠊᝈ⪅ࡢᗫ⏝ೃ⩌ࡀ㐍⾜ࡋࠊᚰ ⫵ᶵ⬟ࡢపୗࡼࡿ་Ꮫⓗ⟶⌮ࡀᚲせ࡞ࢀࡤࠊࡇࢀࡣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ᪨ ࡽᮏᮎ㌿ಽ࡛࠶ࡿࠋ ᪥ᮏసᴗ⒪ἲኈ༠⚟㒊ࡣ 2004 ᖺᅜࡢసᴗ⒪ἲኈࡽ↓సⅭᢳฟࡋࠊస ᴗ⒪ἲᐇ୰㉳ࡇࡗࡓᨾ㛵ࡍࡿࣥࢣ࣮ࢺㄪᰝࢆ⾜ࡗ࡚࠸ࡿࠋࡑࡇ࡛ࡣ㌿ಽ࣭ ㌿ⴠࡀ᭱ࡶከࡃࠊḟ࠸࡛ࢳ࣮ࣗࣈ㢮ࡢ⟶⌮࡞ࡗ࡚࠸ࡓ㸦᪥ᮏసᴗ⒪ἲኈ༠⚟㒊 2005 p.302㸧ࠋࡲࡓࠊᨾࡢせᅉࡋ࡚ࡣほᐹ༑ศ࣭ὀពࠊ㸦ᝈ⪅ࡢ㸧ΰ㞧࣭㸦స ᴗ⒪ἲኈࡢ㸧ከᛁࡀከ࠸⤖ᯝ࡞ࡗ࡚࠸ࡓ㸦᪥ᮏసᴗ⒪ἲኈ༠⚟㒊 2005 p.302㸧ࠋ ࡇࡢ㌿ಽࡸࢳ࣮ࣗࣈ⟶⌮ࡼࡿᨾࡣసᴗ⒪ἲኈ≉␗ⓗ࡞ࡶࡢ࡛ࡣ࡞࠸ࠋබ┈♫ᅋ ἲே᪥ᮏ་⒪ᶵ⬟ホ౯ᶵᵓࡀ⾜ࡗ࡚࠸ࡿ་⒪ᨾሗ㞟ᴗ࠾࠸࡚ࡶᨾࡢୖ ࢆ༨ࡵ࡚࠸ࡿ 13㸧ࠋࡇࡢ⤖ᯝࡽ⪃࠼ࡽࢀࡿࡇࡣࠊࡇࢀࡽࡢᨾࡢཎᅉࡢከࡃࡣࣄࣗ ࣮࣐࢚࣮ࣥࣛᣐࡗ࡚࠸ࡿࡀࡁ࠸ࡢ࡛࠶ࡾࠊసᴗࡑࡢࡶࡢࡀ༴㝤࡛࠶ࡿ᩿ᐃ ࡍࡿࡶࡢ࡛ࡣ࡞࠸ࠋᨾ㜵Ṇດࡵࡿࡓࡵࡣࠊ་⒪ࢳ࣮࣒ࡋ࡚ࡢ⤌⧊ⓗᑐ⟇ࡀᚲ せ࡞ࡿࡢ࡛࠶ࡾࠊసᴗ⒪ἲࡢྍྰࢆ་ᖌࡀุ᩿ࡋࡓࡽ࠸ࡗ࡚ࠊࡇࢀࡽࡢᨾ௳ ᩘࡀῶᑡࡍࡿࡣ⪃࠼ࡃ࠸ࠋ ࡇࢀࡽࡽ⪃࠼ࡿ་⾜Ⅽࡢព⩏ࡣࠊᝈ⪅ࡢᚰ㌟ࡀ༴㝤ࡉࢀࡓሙྜࠊࡑࡢἲ ⓗ㈐௵ࢆࠕㄡࡀࡿࠖࡘ࠸࡚ᬯ♧ࡋ࡚࠸ࡿࡔࡅ㐣ࡂ࡞࠸࠸࠼ࡿࠋ་⾜Ⅽࢆࠕ་ ⾜Ⅽ࡛࠶ࡿ᩿ࠖゝࡍࡿࡓࡵࡣࠊ࠶ࡿ⾜Ⅽࢆᝈ⪅⾜ࡗࡓሙྜࡑࡢ⾜Ⅽࡀࡢ⛬ ᗘ༴㝤࡛࠶ࡿࢆ᫂☜࡛ࡁ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋసᴗ⒪ἲ࡛⏝࠸ࡿసᴗࡣࠊ⸆≀⒪ἲ ࡸᡭ⾡⒪ἲࡢࡼ࠺᫂ࡽᝈ⪅ᑐࡋ࡚⏕≀Ꮫⓗ࡞くຍ࠼ࡿࡶࡢ࡛ࡣ࡞࠸ࠋ࠼ ࡤࠕࡍࡈࢁࡃ࡛㐟ࡪࠖࡇࡸࠕࡦ࡞ࡲࡘࡾࢆᴦࡋࡴࠖࡇࡀᝈ⪅ᑐࡋ࡚ࡢࡼ࠺࡞ くࢆ⏕ࡳฟࡍ࡛࠶ࢁ࠺ࠋࡇࢀࡽࡢసᴗ༴㝤ᛶࡀ࠶ࡿ᫂☜࡛ࡁ࡞࠸㝈ࡾࠊࡇ ࢀࡽࡢసᴗࡣ་⾜Ⅽࡣ␗࡞ࡿࡶࡢ⪃࠼ࡿࡁ࡛࠶ࡿࠋ ࡶࡕࢁࢇࠊసᴗ⒪ἲࢆᚲせࡍࡿᝈ⪅ࡢከࡃࡣࠊసᴗ⒪ἲࢆ㛤ጞࡍࡿⅬ࠾࠸࡚ ఱࡽࡢࣜࢫࢡࢆᢪ࠼࡚࠸ࡿࠋࡋࡓࡀࡗ࡚ࠊࣜࢫࢡ⟶⌮ࡣ⥥ᐦ⾜ࢃ࡞ࡅࢀࡤ࡞ࡽ࡞ ࠸ࠋࡑࡇࡣ་ᖌࡢຊࡀᚲせ࡛࠶ࡿࠋࡋࡋࠊࡑࡢࡇࡀసᴗ⒪ἲࢆ་⾜Ⅽࡢ୰ྵ ࡵࡿ࠸࠺᰿ᣐࡣ࡞ࡽ࡞࠸ࠋ་ᖌࡀ᥎ᐹࡍࡿᝈ⪅ࡢࣜࢫࢡࡣ࠶ࡃࡲ࡛ࡶᝈ⪅ࡽࡢ ་Ꮫⓗሗ࡛࠶ࡿࠋ་ᖌࡢ་Ꮫⓗぢᆅᇶ࡙ࡃሗసᴗ⒪ἲኈࡢぢᆅᇶ࡙࠸ࡓᝈ ⪅ࡢసᴗࡢ㑅ᢥࡢ㛫㝵ᒙᛶࡣ࡞࠸ࡢ࡛࠶ࡾࠊ᪉ࡣඹ᭷ࡉࢀࡿࡁࡶࡢ࡛࠶ࡿࠋ 㸴㸬⤯ᑐⓗ㸦࠾ࡼࡧ┦ᑐⓗ㸧సᴗ⒪ἲ⾜Ⅽࡢྍ⬟ᛶ ➹⪅ࡣࡇࡇࡲ࡛ࡢ㆟ㄽ࡛ࠊ⌧ᅾࡢసᴗ⒪ἲ⌮ㄽ࠾ࡼࡧᏛၥᇶ࡙࠸ࡓసᴗ⒪ἲࡀ་ ⾜Ⅽࡣゝ࠼࡞࠸ࡇࢆᙇࡋࡓࠋࡑࢀ࡛ࡣసᴗ⒪ἲࡀ་⾜Ⅽ࡛࡞࠸ࡍࢀࡤࠊసᴗ ⒪ἲࡣ་⒪࡛ࡣ࡞࠸ゝ࠼ࡿࡔࢁ࠺ࠋࡇࡢⅬࡘ࠸࡚ࡣࡑ࠺ゝ࠸ษࢀ࡞࠸⪃࠼ࡿࠋ - 42 - ་⒪ࡀ་⾜Ⅽࡢ⥲⛠ࡉࢀ࡚࠸ࡿࡇࡣඛ♧ࡋࡓ㏻ࡾ࡛࠶ࡿࠋࡋࡋࠊࡑࡶࡑࡶࠊ ࠕࢳ࣮࣒་⒪ࠖ࠸࠺ゝⴥࡶ࠶ࡿࡼ࠺ࠊ་ᖌࡔࡅࡀ་⒪ࢆ⾜ࡗ࡚࠸ࡿࢃࡅ࡛ࡣ࡞࠸ࠋ ᝈ⪅ࡢ༴㝤ᛶ㧗పࡀ࠶ࡗࡓࡋ࡚ࡶࠊᝈ⪅ࢆ࠶ࡿ⏕ά≧ែࡽࡼࡾⰋ࠸≧ែ࡞ࡿ ࡼ࠺ാࡁࡅࡿసᴗ⒪ἲኈࡢࠕ་⒪ࡢᑓ㛛⫋ࡋ࡚ࡢࠖᙺࡣసᴗ⒪ἲኈࡢㄌ⏕௨᮶ ኚࢃࡽ࡞࠸ࠋࡑ࠺ࡍࡿࠊసᴗ⒪ἲࡣ་⾜Ⅽࡣ␗࡞ࡿసᴗ⒪ἲኈࡼࡿ⊂⮬ᛶࢆᣢ ࡗࡓ⮫ᗋᐇ㊶࡞ࡗ࡚࠸ࡿゝ࠼ࡿࠋࡑࡋ࡚ࠊࡇࡢసᴗ⒪ἲኈࡼࡿ⊂⮬ᛶࢆᣢࡗࡓ ᐇ㊶ࡶ་⒪ࡢ୰ྵࡲࢀࡿ⪃࠼ࡿࠋ ࡇࡢࡼ࠺⪃࠼ࡿࠊ་⾜Ⅽࡣ␗࡞ࡿసᴗ⒪ἲኈࡢᝈ⪅ࡢධࡣࠊసᴗ⒪ἲኈ ࡔࡅࡀ⾜࠼ࡿ⤯ᑐⓗ࡞ࡶࡢ࡛࠶ࡿྰࢆ᳨ウࡍࡿవᆅࡀ࠶ࡿࠋࡶࡋࠊࡑࢀࡀᏑᅾࡍ ࡿࡢ࡛࠶ࢀࡤࠊసᴗ⒪ἲኈࡣࡑࢀࢆ᰿ᣐᑓ㛛⫋ࡋ࡚ࡢ⊂⮬ᛶࢆ☜❧࠾ࡼࡧ⥔ᣢ࡛ ࡁࡿᛮࢃࢀࡿࡽ࡛࠶ࡿࠋ ࡇࡢࡇ㛵ࡋ࡚ࠊ┳ㆤ࡛ࡣ⯆῝࠸ぢゎࡀ࠶ࡿࠋ┳ㆤᖌ࡛࠶ࡿ▼ࢺࢡࡣࠊ་ᖌ ࡀᑟࡍࡿ་⾜Ⅽࡣูࡢ┳ㆤᖌࡀᑟࡍࡿ┳ㆤ⾜Ⅽ࠸࠺ࡶࡢࢆ༊ูࡋ࡚࠸ࡿࠋࡑ ࡢ᰿ᣐࡣಖᖌຓ⏘ᖌ┳ㆤᖌἲ➨᮲࠾࠸࡚ࠊ┳ㆤᖌࡀࠕ⒪㣴ୖࡢୡヰཪࡣデ⒪ࡢ ⿵ຓࢆ⾜࠺ࡇࢆᴗࡍࡿࠖ࠸࠺᮲ᩥ࠶ࡿࠋࡑࡋ࡚ࠊ┳ㆤ⾜Ⅽࡢ୰࡛┦ᑐⓗ┳ㆤ ⾜Ⅽ⤯ᑐⓗ┳ㆤ⾜Ⅽ༊ศࡋ࡚࠸ࡿࠋ▼ࡼࢀࡤࠊ┦ᑐⓗ┳ㆤ⾜Ⅽࡣࠕデ⒪ ࡢ୍㒊࡛࠶ࡿࡢ࡛ࠊ⾜ⅭࡢỴᐃࡣ་ᖌࡢᣦ♧ࡀ᮲௳࡞ࡿࡀࠊࡑࡢ⾜Ⅽࡣ┳ㆤᖌ ࡋ࡚ࡢ┳ㆤุ᩿ᢏ⾡ࡢ⤫ྜ࡛࠶ࡿ࡛ࠖ࠶ࡿ㸦▼ 2011 p.206㸧ࠋࡑࡋ࡚⤯ᑐⓗ┳ㆤ ⾜Ⅽࡣࠕ⒪㣴ୖࡢୡヰ⛠ࡉࢀࡿ┳ㆤᖌ⊂⮬ࡢᴗົ࡛࠶ࡾࠊ་ᖌࡢᣦ♧ࠊᣦᑟ┘╩ ࢆᚲせࡋ࡞࠸ࠖᐃ⩏ࡉࢀ࡚࠸ࡿ㸦▼ 2011 p.207㸧ࠋ ࡇࡢᐃ⩏ࢆࡶ⪃࠼ࡿࠊࡇࢀࡲ࡛㏙࡚ࡁࡓసᴗ⒪ἲኈࡢ⾜Ⅽࡘ࠸࡚ࠊసᴗ ⒪ἲ⌮ㄽࢆ⏝࠸࡚ಶேࡗ࡚ពࡀ࠶ࡿࡉࢀࡿᩥࡸ♫ࢆᫎࡋࡓసᴗࢆ⏝࠸ ࡿ⊂⮬ᛶࡢ㧗࠸⾜Ⅽࡣࠕ⤯ᑐⓗసᴗ⒪ἲ⾜Ⅽࠖࠊ⌮Ꮫ⒪ἲࡸࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་Ꮫ 㔜」ࡍࡿឤぬ࣭㐠ືάືࡸ⏕άάືࢆసᴗࡋ࡚⏝࠸ࡿሙྜࡣࠕ┦ᑐⓗసᴗ⒪ἲ⾜Ⅽࠖ ࠸࠺ࡼ࠺࡞ᐃ⩏࡙ࡅࡀྍ⬟࡛࠶ࡿ⪃࠼ࡿࠋ 㸵㸬࠾ࢃࡾ ᮏ✏࡛ࡣసᴗ⒪ἲ࠾ࡅࡿ⌮ㄽ࠾ࡼࡧᐇ㊶ࡢṔྐⓗኚ㑄ἲ௧ୖࡢ་⾜Ⅽᴫᛕࢆ ⪃ࡋ࡞ࡀࡽࠊసᴗ⒪ἲኈࡢᑓ㛛⫋ࡋ࡚ࡢ⊂⮬ᛶࢆぢฟࡑ࠺ࡋࡓࠋࡑࡢ⤖ᯝࠊసᴗ ⒪ἲኈࡀᝈ⪅ࡢᩥࢆᫎࡋࡓࠕసᴗࠖࢆධᡭẁࡋ࡚⏝࠸ࡿసᴗ⒪ἲࡣࠊ་⾜Ⅽ ࡣぢ࡞ࡉࢀ࡞࠸ࡇࢆ᫂ࡽࡋࡓࠋࡑࡋ࡚ࠊసᴗ⒪ἲኈࡣ་ᖌࡢ♧၀ࢆཷࡅ࡞ࡀ ࡽࡶ⊂⮬ࡢどⅬ࡛సᴗ⒪ἲࢆᒎ㛤ࡋ࡚࠾ࡾࠊࡑࡢព࡛┦ᑐⓗసᴗ⒪ἲ⾜Ⅽ࠾ࡼࡧ⤯ ᑐⓗసᴗ⾜Ⅽ࠸࠺ᐃ⩏࡙ࡅࡀ࡛ࡁࡿྍ⬟ᛶࢆᣦࡋࡓࠋ సᴗ⒪ἲࡣἲ௧ୖࠊಖᖌຓ⏘ᖌ┳ㆤᖌἲつᐃࡉࢀࡓデ⒪ࡢ⿵ຓ࠸࠺┳ㆤᖌࡢ ᴗົ⊂༨ࡢእつᐃ࡛࠶ࡿࠋ᪥ᮏ┳ㆤ༠ࡀࠕᅜẸࡢ㉁ࡢ㧗࠸་⒪ࡢᥦ౪ࠖࢆ┠ⓗ ᥎㐍ࡍࡿㄆᐃ┳ㆤᖌไᗘ࡛ࡣࠊ2008 ᖺࡽࠕ⬻༞୰ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ┳ㆤࠖࡀ≉ - 43 - ᐃࡉࢀࠊ2013 ᖺ 1 ᭶⌧ᅾ 290 ྡ 14㸧ࡢㄆᐃ┳ㆤᖌࡀᑓ㛛ᛶࡢ㧗࠸ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ ┳ㆤࢆᐇ㊶ࡋ࡚࠸ࡿࠋࡇࡢࡇࡽࠊసᴗ⒪ἲࡢᑓ㛛ᛶࢆᙇࡍࡿࡓࡵࡣ┳ㆤࡢ ␗ྠࢆ☜ㄆࡍࡿᚲせࡀ࠶ࡿࡀࠊࡇࡢⅬࡘ࠸࡚ࡣ✏ࢆᨵࡵ࡚ㄽࡌࡓ࠸ࠋ ὀ 㸯㸧㟁Ꮚᨻᗓࡢ⥲ྜ❆ཱྀ࣮࢝ࣈ ἲ௧ࢹ࣮ࢱᥦ౪ࢩࢫࢸ࣒࣮࣒࣮࣍࣌ࢪ http://law.e-gov.go.jp/htmldata/S40/S40HO137.html㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 㸰㸧2005 ᖺ 7 ᭶ 26 ᪥ࡢཌ⏕ປാ┬ࡼࡿ⾜ᨻ㏻▱ࠕ་ᖌἲ➨ 17 ᮲ࠊṑ⛉་ᖌἲ➨ 17 ᮲ཬࡧಖᖌຓ⏘ᖌ┳ㆤᖌἲ➨ 31 ᮲ࡢゎ㔘ࡘ࠸࡚ࠖཌ⏕ປാ┬࣮࣒࣮࣍࣌ࢪ http://www.mhlw.go.jp/stf/shingi/2r9852000000g3ig-att/2r9852000000iiut.pdf 㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧࠾࠸࡚ࡶࠊྠࡌᩥ࡛་⾜Ⅽࢆᐃ⩏ࡋ࡚࠸ࡿࠋ 㸱㸧ಖᖌຓ⏘ᖌ┳ㆤᖌἲ➨୕༑୍᮲ࡣࠕ┳ㆤᖌ࡛࡞࠸⪅ࡣࠊ➨᮲つᐃࡍࡿᴗ ࢆࡋ࡚ࡣ࡞ࡽ࡞࠸㸦௨ୗ␎㸧ࠖ࠶ࡿࠋࡑࡋ࡚ࠊࡇࡇ࡛࠸࠺ಖᖌຓ⏘ᖌ┳ㆤᖌἲ➨ ᮲࡛ࡣࠊ ࠕࡇࡢἲᚊ࠾࠸࡚┳ㆤᖌࡣࠊཌ⏕ປാ⮧ࡢචチࢆཷࡅ࡚ࠊയ⪅ⱝࡋࡃ ࡣࡌࡼࡃ፬ᑐࡍࡿ⒪㣴ୖࡢୡヰཪࡣデ⒪ࡢ⿵ຓࢆ⾜࠺ࡇࢆᴗࡍࡿ⪅ࢆ࠸࠺ࠖ つᐃࡉࢀ࡚࠸ࡿࠋࡑࡋ࡚ࠊ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲ➨༑᮲ࡣࠕ⌮Ꮫ⒪ἲኈཪ ࡣసᴗ⒪ἲኈࡣࠊಖᖌຓ⏘ᖌ┳ㆤᖌἲ➨୕༑୍᮲➨୍㡯 ཬࡧ➨୕༑᮲ࡢつᐃ ࢃࡽࡎࠊデ⒪ࡢ⿵ຓࡋ࡚⌮Ꮫ⒪ἲཪࡣసᴗ⒪ἲࢆ⾜࡞࠺ࡇࢆᴗࡍࡿࡇࡀ࡛ ࡁࡿࠖࡇࡀ᫂グࡉࢀ࡚࠸ࡿࠋ 㸲㸧⤫ィᒁ࣮࣒࣮࣍࣌ࢪ http://www.jpo.go.jp/shiryou/toushin/shingikai/pdf/iryo_wg1/tokkyo_iryou_siryou5. pdf㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 㸳㸧ᅜᐙ㈨᱁ࡋ࡚ࡢసᴗ⒪ἲኈࢆᡤ⟶ࡍࡿཌ⏕ປാ┬ࡣ 2010 ᖺ 4 ᭶ 30 ᪥ࠕ་⒪ ࢫࢱࢵࣇࡢ༠ാ࣭㐃ᦠࡼࡿࢳ࣮࣒་⒪ࡢ᥎㐍ࡘ࠸࡚ࠖ㢟ࡍࡿ⾜ᨻ㏻▱ࢆⓎฟࡋ ࡓ㸦ཌ⏕ປാ┬࣮࣒࣮࣍࣌ࢪ http://www.mhlw.go.jp/shingi/2010/05/dl/s0512-6h.pdf 2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 ࠋࡇࡢ୰࡛ࡣ๓㏙ࡋࡓ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲ࠾ࡅ ࡿసᴗࡀ་⒪⌧ሙ࠾࠸࡚ᡭᕤⱁࢆ⾜ࢃࡏࡿࠖ࠸࠺೫ࡗࡓㄆ㆑ࢆ⏕ࡳฟࡍྍ⬟ᛶ ࠸࠺Ⅼࡽࠊḟࡢ 6 㡯┠࠾࠸࡚ࡶసᴗ⒪ἲࡢ⠊ᅖྵࡲࢀࡿ᫂グࡋࡓࠋ 1. ⛣ືࠊ㣗ࠊἥࠊධᾎ➼ࡢ᪥ᖖ⏕άάື㛵ࡍࡿ ADL カ⦎ 2. ᐙࠊእฟ➼ࡢ IADL カ⦎ 3. సᴗ⪏ஂᛶࡢྥୖࠊࠗసᴗᡭ㡰ࡢ⩦ᚓࠊᑵປ⎔ቃࡢ㐺ᛂ➼ࡢ⫋ᴗ㛵㐃άືࡢ カ⦎ 4. ⚟♴⏝ලࡢ⏝➼㛵ࡍࡿカ⦎ 5. ㏥㝔ᚋࡢఫ⎔ቃࡢ㐺ᛂカ⦎ - 44 - 6. Ⓨ㐩㞀ᐖࡸ㧗ḟ⬻ᶵ⬟㞀ᐖ➼ᑐࡍࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ 㸴㸧୍⯡♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠࣮࣒࣮࣍࣌ࢪ http://www.jaot.or.jp/ryohoshi/swf/info-4.swf㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 㸵㸧సᴗ⒪ἲኈࡀ㝔ࡸデ⒪ᡤ࠾࠸࡚ᚑࡍࡿ࠸࠺㡿ᇦࢆ♧ࡍࠋ 㸶㸧ᑐ㇟ᝈࡘ࠸࡚ࠊ65 ṓᮍ‶࡛ࡣ⬻⾑⟶ᛶ㞀ᐖࠊ㦵ᢡࠊ㧗ḟ⬻ᶵ⬟㞀ᐖࡢ㡰ከ ࡃࠊ65 ṓ௨ୖ࡛ࡣ⬻⾑⟶ᛶ㞀ᐖࠊ㦵ᢡࠊࣃ࣮࢟ࣥࢯࣥࡢ㡰ከ࠸⤖ᯝ࡞ࡗ࡚࠸ࡿ 㸦♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠ 2012㸪pp.29-30㸧ࠋ 㸷㸧ᑐ㇟ᝈࡘ࠸࡚ࡣࠊ⤫ྜኻㄪ㸦97.3㸣㸧ࠊឤ㞀ᐖ㸦92.2㸣㸧ࠊㄆ▱ࡸே᱁࣭ ⾜ື㞀ᐖ࡞ࡢჾ㉁ᛶ⢭⚄㞀ᐖ㸦90.7㸣㸧ࡢ㡰ከ࠸⤖ᯝ࡞ࡗ࡚࠸ࡿࠋ୍⯡♫ᅋἲ ே᪥ᮏసᴗ⒪ἲኈ༠࣮࣒࣮࣍࣌ࢪ http://www.jaot.or.jp/wp/wp-content/uploads/2012/08/teisei-whitepaper-2010.pdf 㸦2012 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 ࠋ 10㸧᪥ᮏ⬻༞୰Ꮫ࣮࣒࣮࣍࣌ࢪ http://www.jsts.gr.jp/jss08.html㸦2013 ᖺ㸯᭶ 13 ᪥ࢡࢭࢫ㸧 11㸧᪥ᮏ⬻༞୰Ꮫ࣮࣒࣮࣍࣌ࢪ http://www.jsts.gr.jp/guideline/289_290.pdf㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 12㸧ࡢసᴗ⒪ἲࡢᐇ㊶࡛ࡣࠊᝈ⪅ࡢ⒪㣴࠾ࡅࡿ᪥ㄢࢆᏳ㟼⪅ࠊṌ⾜⪅ࠊ㍍సᴗᚑ ⪅ࠊ୰➼ᗘ సᴗᚑ ⪅ࠊᐇ⏕ά ᖐ‽ഛ⪅ ࡢ 5 ᮇศ㢮ࡋ࡚ ࠸ ࡓ㸦 1947 pp.259-64㸧ࠋᝈ⪅ࡢ 1 ᪥ࡢ⏕ά࠾ࡅࡿάື㔞ࡣᮇࡀ㐍ࡴࡘࢀ࡚ቑຍࡍࡿෆᐜ࡛࠶ ࡗࡓࠋࡇࡢάື㔞ࢆ㌟యࡿ㈇Ⲵࡋ࡚ࡽ࠼ࡓࡶࡢᛮࢃࢀࡿࠋ 13㸧᪥ᮏ་⒪ᶵ⬟ホ౯ᶵᵓ࣮࣒࣮࣍࣌ࢪ http://www.med-safe.jp/contents/report/html/StatisticsMenu.html㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 14 㸧 ᪥ ᮏ ┳ ㆤ ༠ ࣍ ࣮ ࣒ ࣌ ࣮ ࢪ http://nintei.nurse.or.jp/nursing/qualification/cn 㸦2013 ᖺ 1 ᭶ 13 ᪥ࢡࢭࢫ㸧 ཧ⪃ᩥ⊩ Baum C.㸦᪥ᇉ୍⏨ࠊ⏣࠶ࡁᏊヂ㸧 㸦2000㸧 ࠕኚࡍࡿಖ་⒪ไᗘ࠾ࡅࡿࢡࣛ ࢚ࣥࢺ୰ᚰࡢᐇ㊶ࠖࠊLaw, M ⦅ⴭ㸦ᐑ๓⌔Ꮚࠊ㛗㇂㱟ኴ㑻┘ヂ㸧 ࠗࢡ࢚ࣛࣥࢺ୰ᚰࡢ సᴗ⒪ἲ ࢝ࢼࢲసᴗ⒪ἲࡢᒎ㛤࠘ࠊ༠ྠ་᭩ࠊpp.31-50 Baton GE㸦1915㸧͆Occupational Therapy”㸪 The Trained Nurse and Hospital Review, Vol.54, No.3, pp.138-40 ࢝ࢼࢲసᴗ⒪ἲኈ༠㸦ྜྷᕝࡦࢁࡳヂ㸧 㸦2000㸧ࠗసᴗ⒪ἲࡢどⅬ సᴗࡀ࡛ࡁࡿ࠸ ࠺ࡇ࠘ࠊᏛᩍ⫱ฟ∧ ⰾ㈡ᩄᙪ㸦1976㸧ࠕ⌮Ꮫ⒪ἲኈཬࡧసᴗ⒪ἲኈἲࡢṔྐࠖࠊࠗ⌮Ꮫ⒪ἲసᴗ⒪ἲ࠘10 ᕳ 11 ྕࠊpp.843-7 - 45 - ༤⏣⠇ኵ㸦1986㸧 ࠕసᴗ⒪ἲ࣭ࡑࡢ᰾ࢆၥ࠺ ་ᖌࡢ❧ሙࡽࠖࠊ ࠗసᴗ⒪ἲ࠘➨ 5 ᕳ 2 ྕࠊp.267 㛗㇂㱟ኴ㑻ࠊ㸦2001㸧ࠕసᴗ⒪ἲኈࡢ⫋ᴗࢹࣥࢸࢸ◊✲ࡢᒎᮃࠖࠊࠗⲈᇛ┴ ❧་⒪Ꮫ⣖せ࠘6 ᕳࠊpp.47-56 ᵽཱྀ⠊㞝㸦2009㸧ࠕ་⾜Ⅽᴫᛕࡢ᳨ウࠖࠊᵽཱྀ⠊㞝࣭ᒾ⏣ኴ⦅ࠗ⏕⌮ἲ࠘ࠊᘯ ᩥᇽ ▼ࢺࢡ㸦2011㸧ࠕ┳ㆤ⫋ࡢᑓ㛛ᛶࢆ⏕ࡍࠖࠊ㧗ᶫ㝯㞝࣭ᮧಇ๎⦅ࠗ་⒪ࡢᮏ㉁ ኚᐜ࠘ࠊᕞᏛฟ∧ࠊpp.189-212 ᒾ㷂Ύ㝯㸦2012㸧 ࠕ᪥ᮏࡢ㐟ࡧసᴗ⒪ἲࠖࠊ ࠗసᴗ⒪ἲࢪ࣮ࣕࢼࣝ࠘46 ᕳ 10 ྕࠊ pp.1260-4 㙊▴Ꮚࠊ㸦1975㸧ࠕ⚾ࡢ⪃࠼ࡿ OTࠖࠊ♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠ࠗ♫ᅋἲே᪥ ᮏసᴗ⒪ἲኈ༠ 25 ࿘ᖺグᛕㄅ ࢩ࣮ࣜࢬసᴗ⒪ἲࡢ᰾ࢆၥ࠺࠘ࠊ♫ᅋἲே᪥ᮏసᴗ ⒪ἲኈ༠ࠊpp.3-23 Kielhofner G㸦ᒣ⏣Ꮥヂ㸧 㸦2011a㸧 ࠕே㛫సᴗࣔࢹࣝࡢ࠸ࡊ࡞࠸ࠖࠊKielhofner G, ed. 㸦ᒣ⏣Ꮥ┘ヂ㸧ࠗே㛫సᴗࣔࢹࣝ ⌮ㄽᛂ⏝➨ 4 ∧࠘ࠊ༠ྠ་᭩ࠊpp.1-7 Kielhofner G㸦ᒣ⏣Ꮥヂ㸧 㸦2011b㸧ࠕసᴗࡢᇶᮏⓗᴫᛕࠖࠊKielhofner G, ed.㸦ᒣ⏣Ꮥ ┘ヂ㸧ࠗே㛫సᴗࣔࢹࣝ ⌮ㄽᛂ⏝➨ 4 ∧࠘ࠊ༠ྠ་᭩ࠊpp.11-24 Kielhofner G㸦ᒣ⏣Ꮥヂ㸧 㸦2011c㸧 ࠕ⾜ⅭࡢㅖḟඖࠖࠊKielhofner G, ed.㸦ᒣ⏣Ꮥ┘ヂ㸧 ࠗே㛫సᴗࣔࢹࣝ ⌮ㄽᛂ⏝ ➨ 4 ∧࠘ࠊ༠ྠ་᭩ࠊpp.112-121 㘐ᖹ㸦1947㸧 ࠕసᴗ⒪ἲࠖ ࠊ⛅ඖἼ␃ኵ࣭ᒸペᏊ⦅㸦1991㸧 ࠗ᪂ సᴗ⒪ἲࡢ※ὶ࠘ࠊ ୕㍯᭩ᗑࠊpp.254-70 ᡤ Law, M et al.㸦ᐑ๓⌔Ꮚࠊ㓇ࡦࡳヂ㸧㸦2000㸧ࠕࢡ࢚ࣛࣥࢺ୰ᚰࡢసᴗ⒪ἲࠖࠊ Law, M ⦅ⴭ㸦ᐑ๓⌔Ꮚࠊ㛗㇂㱟ኴ㑻┘ヂ㸧ࠗࢡ࢚ࣛࣥࢺ୰ᚰࡢసᴗ⒪ἲ ࢝ࢼࢲస ᴗ⒪ἲࡢᒎ㛤࠘ࠊ༠ྠ་᭩ࠊpp.1-20 ᐑᓮ᫂⨾㸦2012㸧 ࠕࡢసᴗ⒪ἲ̿WFOT2014 ࢆぢᤣ࠼࡚ ≉㞟࠶ࡓࡗ࡚ࠖࠊ ࠗసᴗ ⒪ἲࢪ࣮ࣕࢼࣝ࠘46 ᕳ 10 ྕࠊpp.1249 ᐑ๓⌔Ꮚ㸦2002㸧ࠕࢡ࢚ࣛࣥࢺ୰ᚰࡢసᴗ⒪ἲసᴗ⒪ἲࡢᏛၥⓗ⨨࡙ࡅࠖࠊࠗస ᴗ⒪ἲ࠘21 ᕳ 6 ྕࠊpp.512-5 ᪥ᮏసᴗ⒪ἲኈ༠つ⣙ጤဨ㸦1986㸧 ࠕ60㸭6㸭13 ⥲࡛᥇ᢥࡉࢀࡓసᴗ⒪ἲᐃ⩏ࠖࠊ ࠗసᴗ⒪ἲ࠘5 ᕳ 1 ྕࠊp.69 ᪥ᮏసᴗ⒪ἲኈ༠⚟㒊㸦2005㸧ࠕࠕసᴗ⒪ἲሙ㠃࠾ࡅࡿ་⒪ᨾᐇែㄪᰝࠖࣥ ࢣ࣮ࢺ⤖ᯝሗ࿌ࠖ ࠊࠗసᴗ⒪ἲ࠘24 ᕳ 3 ྕࠊpp.302-12 㔝⸨ᘯᖾ㸦2003㸧ࠕ᪥ᮏ࠾ࡅࡿసᴗ⒪ἲࡢṔྐศᯒ̿㌟య㞀ᐖ㡿ᇦࢆ୰ᚰࠖࠊࠗస ᴗ⾜ື◊✲࠘7 ᕳ 1 ྕࠊpp.6-16 Polatajiko H et al㸪 㸦ྜྷᕝࡦࢁࡳヂ㸧 㸦2011㸧ࠕ㛵ᚰ㡿ᇦࡢ≉ᐃ㸸᰾ࡋ࡚ࡢసᴗࠖࠊ Townsend E, Polatajiko H, ed.㸦ྜྷᕝࡦࢁࡳ┘ヂ㸧 ࠗ⥆࣭సᴗ⒪ἲࡢどⅬ࠘ࠊᏛᩍ - 46 - ⫱ฟ∧ࠊpp.34-60 Reilly M㸦ᒣ⏣Ꮥヂ㸧㸦1996㸧ࠕసᴗ⒪ἲࡣ 20 ୡ⣖ࡢ೧࡞ほᛕࡢ୍ࡘ࡞ࡾᚓࡿࠖࠊ ࠗసᴗ⾜ື◊✲࠘3 ᕳ 1 ྕࠊpp.53-67 ◁ཎⱱ୍㸦1977㸧ࠕ⌮Ꮫ⒪ἲኈ࣭సᴗ⒪ἲኈἲᡂ❧ࡢࡇࢁࠖࠊࠗ⌮Ꮫ⒪ἲసᴗ⒪ἲ࠘ 11 ᕳ 8 ྕࠊpp.591-7 ♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠Ꮫ⾡㒊㸦2006㸧ࠗసᴗ⒪ἲ࢞ࢻࣛࣥ㸦2006 ᖺᗘ∧㸧ࠊ ♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠ ♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ༠㸦2012㸧 ࠗసᴗ⒪ἲⓑ᭩ 2010࠘ࠊ♫ᅋἲே᪥ᮏసᴗ⒪ἲኈ ༠ ᡭᔱ㇏㸦2008㸧 ࠗ་ἲධ㛛 ➨㸰∧࠘ࠊ᭷ᩫ㛶 ᳺཎᙲኵ㸦2009㸧 ࠕࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⒪࣭カ⦎ฎ᪉ࠖࠊ༓㔝┤୍⦅ࠗ⌧௦ࣜࣁࣅࣜ ࢸ࣮ࢩࣙࣥ་Ꮫ ᨵゞ➨㸱∧࠘ࠊ㔠ཎฟ∧ࠊpp.535-41 ▮㇂௧Ꮚ㸦1985㸧 ࠕసᴗ⒪ἲసᴗࠖࠊ᪥ᮏసᴗ⒪ἲኈ༠⦅ࠗసᴗ࣭ࡑࡢ⒪ⓗᛂ⏝࠘ࠊ ༠ྠ་᭩ࠊpp.3-27 ▮㇂௧Ꮚ㸦1986㸧ࠕసᴗ⒪ἲ࣭ࡑࡢ᰾ࢆၥ࠺ࠖࠊࠗసᴗ⒪ἲ࠘5 ᕳ 2 ྕࠊpp.262-4 ᒣ⏣Ꮥ㸦1982㸧 ࠕゎㄝ సᴗ⾜ື⌮ㄽ㐟ࡧࠖࠊReilly M㸦ᒣ⏣Ꮥヂ㸧 㸦1982㸧 ࠗ㐟ࡧ ᥈⣴Ꮫ⩦࠘ࠊ༠ྠ་᭩ࠊpp.393-406ࠊᡤ ᒣ⏣Ꮥ㸦1985㸧ࠕసᴗ⾜ື⌮ㄽసᴗࠖ ࠊ᪥ᮏసᴗ⒪ἲኈ༠⦅ࠗసᴗ࣭ࡑࡢ⒪ⓗᛂ ⏝࠘ࠊ༠ྠ་᭩ࠊpp.106-22 ᒣ᰿ᐶ㸦2012㸧 ࠕࣁࣞࢣ̿⾜ࡀࡘࡴࡄ⏕άࠖ ࠊࠗసᴗ⒪ἲࢪ࣮ࣕࢼࣝ࠘46 ᕳ 10 ྕࠊ pp.1255-9 ᒣ㔝ඞ᫂㸦2010㸧ࠕసᴗ⒪ἲኈࡀࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࢆᚓࡿࡓࡵࡢㄝ᫂㈐௵ ࡘ࠸࡚ࠖࠊࠗඛ➃⌮◊✲࠘➨ 5 ྕࠊpp.110-35 ྜྷᕝࡦࢁࡳ㸦2005㸧 ࠕసᴗ⒪ἲ࠾ࡅࡿసᴗࡢኚ㑄ࠖࠊ ࠗసᴗ⒪ἲࢪ࣮ࣕࢼࣝ࠘39 ᕳ 12 ྕࠊpp.1160-6 ྜྷᕝࡦࢁࡳ㸦2008㸧ࠗసᴗࡗ࡚ఱࡔࢁ࠺ సᴗ⛉Ꮫධ㛛࠘ࠊ་ṑ⸆ฟ∧ ྜྷᕝࡦࢁࡳ㸦2011㸧ࠕసᴗ⒪ἲࡢṔྐࠖࠊᒾ㷂ࢸࣝᏊ⦅ࠗసᴗ⒪ἲᏛᴫㄽ ➨ 2 ∧࠘ࠊ ་Ꮫ᭩㝔ࠊpp.41-60 Zemke R, Clark F㸦బ⸨๛ヂ㸧 㸦1999㸧ࠕᗎࠖࠊZemke R, Clark F, ed.㸦బ⸨๛┘ヂ㸧 ࠗసᴗ⛉Ꮫ࠘ࠊ୕㍯᭩ᗑࠊpp.xiii-xxiv - 47 -