The Life Worth Living (Ikigai) of the Elderly in Perspectives of the Narratives Tsuruwaka, Mari
i 1 -----------1 2 ------------------------------------5 2-1 -------------------------------------------------------------------------- 5 2-1-1 ---------------------------------------------------------------------------5 2-1-2 ---------------------------------------------------------------------7 2-1-3 --------------------------------------------------9 2-1-4 --------------------------------------------------------------------18 2-1-5 ----------------------------------------21 2-2 -------------------------------------------------------23 2-2-1 -------------------------------------------------------------------------23 2-2-2 ----------------------------------------------------------------------31 2-3 ----------------------------------------------------33 2-3-1 ----------------------------33 2-3-2 ---------36 2-3-3 -----------------------------------------------------41 2-3-4 --------------------------------------------------------43 3 Spiritual Well-being------------------45 3-1 ----------------------------------------------------------45 3-2Spiritual Well-being --------------------------------------------------------------------46 3-2-1 ----------------------------------------------------47 3-2-2 Spiritual Well-being------------------------------------------------------------51
4 --------------------------------------------------------54 4-1 -------------------------------------------------------------------------54 4-2 ----------------------------------------------------------------------------55 4-3 1-101 ----------------------------------------------------------------59 4-4 -----------------------------------------------------------------60 4-4-1 -------------------------------------------------------------------------------------60 4-4-2 ---------------------------------------------------65 4-4-3 -------------------------------------------------------------------------68 4-4-4 -------------------------------------------------------------------------71 4-5 ------------------------------------------------------------------------74 4-6 ------------------------------------------------------------------78 4-6-1 ------------------------------------------------------------------------------78 4-6-2 ------------------------------------------------------------------------------79 4-6-3 -----------------------------------------------------------------------------------82 4-6-4 ------------------------------------------------------------------------------97 4-74 ------------------------------------------------------------------------------------99 5 --------------------------------------101 5-1 -------------------------------------------------------------------------101 5-2 ----------------------------------------------------------------------104 5-3 -------------------------------------------------------------------------104 5-4 A-------------------------------------------------------------------105 5-5 B-------------------------------------------------------------------108 5-6 C-------------------------------------------------------------------111 5-7 D------------------------------------------------------------------116 5-84 ----------------------------------------------------------------------------------118 5-9 ------------------------------------------------------------------------121 5-9-1 Spiritual --------------------------------------------------121 5-9-2 Spiritual -----------------------------------------------121
iii 6 ------------------------------------------------------------------123 6-1 -----------------------------------------------------123 6-1-1 ------------------------------------------------------------------123 6-1-2 ---------------------------------------------------------------------126 6-2 ---------------------------------------------------------------------------------128 6-2-1 ------------------------------------------------------------------------------128 6-2-2 --------------------------------------------------------------------128 6-2-3 --------------------------------------------------------------------129 6-2-4 --------------------------------------------------------------130 6-2-5 ------------------------------------------------------------------------------130 6-3 Spiritual Well-being------------------------------------------------------------132 6-4 ----------------------134 1-51---------------------------------------135 52-73-------------------------------------229 74-80-------------------------------------244 81-101-----------------------------------261 A-D--------------5-4, 5-5, 5-6, 5-7 -------------------------------------------------------------------------------------------------------------------275 ---------------------------------------------------------------------------------------------------------277 ------------------------------------------------------------------------------------------------------277 ------------------------------------------------------------------------------------------------------286 ----------------------------------------------------------------------------------------------------------------291
1 1 : successful aging quality of life 2001a 65-74 75 1298 895 2000 10 2016 1698 2022 narrative 3 1 4 5 2
2 2 3 Spiritual Well-being 1 Spiritual Well-being Spiritual Well-being Spiritual Well-being 3 Spiritual Well-being 6-3 narrative narrative therapy narrative approach, 2001 Freedman Comb1996 Narrative Therapy 1997, 1999, 1999 1997 narrative ethics
Hunter, 1995 Hunter, 1996; Ellos, 1998 Charon, et al, 1996The American Journal of Bioethics 2 Chamber2001 Evidence Based Medicine: EBM, 1999, 2002 Narrative Based Medicine, 2001; Greenharlgh, 1999; Elwyn, et al, 1999 1971 Greenharlgh, et al, 1999 EBM Greenharlgh, 1999 Nicholas, 1997; Jones, 1997; Greenharlgh, et al, 1999 3
4, 2001 2000 narrative gerontology 4 Koch, 2000: Kenyon, et al, 2001; Randall and Gary, 2001; Birren and Cochran, 2001, 1999, 2002, 1996 6 1 1
5 2 2-1 2-2 2-3 3 2-1 2-1-1 2001 1972 2001
, 1980, p.14, 1989, p.23 1997, 1998, 1999 2-3-2 1999 meaning of life worth livingthe object of satisfaction or happinessthe most important thing, 1997, 1998, 1999 ragione d essere appagamento nella vitalo scopo di vivere la cosa piu importante nella vitaprospettive per il futuro la positivita di una persona, 1999 laison d être joie de vivre, 1999, 1998 2001 2-3-3 6
7, 2001 2-1-2 1971 p.1 1 2, 1971 1980 p.273 p.273 2001 1960-70 1960 1964 1965 1690-70 3 1960 15 3 1 2
8 1968 3 2 4 1970 108 1960 1960 1970 1970 1958 1974 1974 1973 1973 1972 1970 1960 1956, 1956 1960 1970 1960 1968,
9 1995 1999 p.42 2-1-3 1980 2 1980
10, 1980 1989 1971 3, 1971 1974 2, 1974 1994, 1994 1980 7 pp.88-91
11 4, 1980, pp.33-34, 1980, 1989, p.27, 1989, 1980, p.34 1965 1
12, 1965, pp.68-69 2, 1965, 1965, 1965, 1965 1980, 1980 1989 (1) 1964 (2) 1983 (3) 1989
13 (4) 1992 1997 (5) 1996 (6) 1998 (1) 1964 5 1966 1964 1962 7 10 2 12 12 12 2
14 (2) 1983 6 2000 75 7 7 (3) 1989 7 65 418
15 4 4 (4) 1992 1997 8 1991 1991 1 1996 2 8 2 1 12.2 OB
16 OB 2 1 2 OB 2 1 2 1 2 (5) 1996 9 1996 60 2364 78.6 39.0 39.6 17.9 15.6 2.2 44.1 33.5 31.8 30.7 41.5 37.5 35.3
17 49.0 34.8 34.8 (6) 1998 10 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 8 1211 60-64 14.1 65-69 13.0 70-74 12.7 75-79 11.1 80-84 8.6 1 7 2 3 1 2 3 6
18 2-1-4 successful aging 1960-70 activity theory disengagement theory morale life satisfaction morale Kutner 1956, 1993 Neugarten 1961 Life Satisfaction Index ALawton1975 PGC Philadelphia Geriatric Center Morale Scale, 1982, 1983 Larson197830 subjective well-being 1993 Larson subjective well-being
1979 subjective well-being PGC Philadelphia Geriatric Center Morale ScaleLawton, 1975 Lawton197522 PGC 17 PGC 17 1 0-17 3... Lawton 3, 1979;, 1981a, 1981a b ALife Satisfaction Index A: LSIANeugarten1961 19
20 10 1 Neugarten 1961..... 5 5 3 ALife Satisfaction Index A 20 0-20 1981 K, 1983
21 1983... 3 K PGC A, 1982;, 1989a, 1990 Activities of Daily Living: ADL, 1981;, 1981b;, 1992a;, 1988, 1989, 1984 1980, 1986 PGC 2002 2-1-5 1980
22 2001 75
23 2-2 1 2-2-1 1863 70 1923 1927 1929, 2002 65 13 1946 1947 1949 3 1950 38, 1988 1955 1959 1962, 1988 1961, 1988
1 2001 1955 1973 1985 1990 2000 1963 1973 1982 1990 8 2000 1986 1992 2001 1989 1994 1995 1996 1999 21 1969 1970 1976 1979 1986 1962 1963 1986 1967 1996 1986 1979 1989 1973 1998 1972 1968 1980 1980 1965 1973 1984 1971 1985 1978 1988 1989 1990 24
25 1960 1960 1962, 1988 60 1963 7 11 133 8 1, 1994 1963 1950 1966 2 150 20, 1988 1960 1968 19 1352 59 41 8000 55 49 27 14 1969 18 1 3 1, 1995 1970 65
26 1000 9, 1970 1970 1969 37 1962 1968, 1988 60, 1996 1960 1965, 1990 1960 1960 1970 1971 1
27 1, 1988 1961 1971 5 1973, 1988 1972 1973, 1974 1970 1979 4, 1979 1979 1979 56 1 2, 1979 1980, 1996 1980, 1989 1960 1970 4 1965 2 1
28 1971 5 3 1973, 1990 1960 1970 1979 1980 1973, 1979 60 65 1980 1986 80 4
29 1980 1986 1963 1979, 1996 1973 1986, 1988 1989 10 20 10, 1991 1990 8 8 1989, 1991
304 2, 1991 1984 1985, 19901988, 19881989, 1990 1980 1990, 2002 10 1994 1995 1996 2000 2000 2004 5 211999 2 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997,1998, 1999 1990 1980 1990 2000 30
31, 2000, 2001, 2002 2-2-2 2001 1960 1970 1968 1963 4 1973 1972 1979 1960 1970 80 1974 1975 1980 1980 1976 1980 1970 1980 1990 2000
32
2-3 2-3-1 2001b, 2002 b1980 1985 1990 1995 2000 5 11 5 1 2 3 4 5 60 1 4 5 33
34 1 4 5 4 2 6 4 89.7 82.1 80.8 79.6 63.9 2 30.8 32.5 29.2 30.7 37.9 1 4 1 2 4 46.1 56.6 44.6 41.5 37.3 29.1 5
35 58.9 33.4 32.5 29.2 21.0 25.5 25.0 21.1 19.7 14.5 61.7 48.9 62.0 41.3 38.6 54.4 92.2 87.1 83.0 75.2 61.0 2 3 65.5 24.7 18.1 14.0 16.3 30.7 18.0 17.3 16.3 16.3 18.3 17.5 17.3 22.9 16.0 16.0 14.4 7 8 65.3 55.1 8 4 5
36 5 2-3-2 1997, 1998, 1999, 1997 12 1 8 2 15 15 8 12 11 1987, 2001 13 3 8 5 13 4 5 9 22 10 12
37 3, 1999, p.7 4 14 2 2 4 6 1, 2001 15 1 6 10 17
38 16 2 8 10 3 4 1 3 17 4 1 5 5 4 18 4 4 8 1
39, 2001 19 10 5 15 20 1 4 2 4 11
40 100 21 100 62 15 47 9
41 2-3-3 22 2001, 2001 1989 1990 104 9 18 9 18 12 6 10 1 20 2 30 3 40 5 50 2 60 3 2, 2001 2001
42 2, 2001, 2001, p.270 4
43 1 2 3 2, 2001, 2001, 2001 2-3-4 1 2 1997, 1998, 1999
44 3 2
3 Spiritual Well-being Spiritual Well-being Spiritual Well-being Spiritual Well-being 6-3 3-1 quality of life 1964 Lyndon, B. Jonson Beah, 19871970 GNPGross Rational Product 1980 1988, 1996 life World Health Organization: WHO, 1996, p.13 WHO WHOQOL 6 The WHOQOL Group, 1995 1996 2 1997 2 45
2-1-4 subjective well-being, 2002 3-2 Spiritual Well-being WHO Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. 26 1998 WHO WHO Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity. 23 1999 5, 2000 24 Spiritual 25 1993 46
p.48 WHO Spiritual Well-being Spiritual 1977 26 Spiritual, 2000, 2002e5-1 Spiritual 6 2001 6 8-9, 27 Spiritual Well-being Spiritual Spiritual Well-being 3-2-1 28 1970 Spiritual Well-being Spiritual Well-being White House Conference on Aging Spiritual Well-being 1961 1 1971 1981 1995 10 Tedrick, 1985;, 1995 1961 1961 2500 947 Religion and Aging 3 47
15 U.S. Department of Health, Education, and Welfare Special Staff on Aging, 1961; White House Conference on Aging, 1960 1971 1971 Spiritual Well-being Spiritual Well-being Moberg1971Spiritual Well-being Spiritual p.3 Spiritual 14 6 8 White House Conference on Aging, 1973 Spiritual Spiritual Spiritual 29 Spiritual 48
NICA Spiritual Well-being National Interfaith Coalition on Aging 1971 Spiritual Well-being 1972 National Interfaith Coalition on Aging NICA NICA Spiritual NICA Spiritual Well-being Spiritual well-being is the affirmation of life in a relationship with God, self, community, and environment that nurtures and celebrates wholenessnational Interfaith Coalition on Aging, 1975, p.4 NICA Spiritual Well-being Spiritual Well-being Spiritual Well-being National Interfaith Coalition on Aging, 1975 1981 1981 NICA Spiritual and Ethical Values System Concerns Spiritual Well-being Cook, et al, 1981 1971 Spiritual Well-being Delloff, 1983Spiritual Well-being 12 Spiritual Well-being Stein, 2001 1995 1995 Spiritual Well-being 11 49
Spiritual, Ethics, Values, and Roles Advance Directive White House Conference on Aging, 1995Erkenbrack, et al, 1995 1961 1995 Spiritual Well-being 1961 1971 1961 Spiritual Well-being Spiritual Spiritual Well-being Moberg, 1978a 1961 1971 Marquette Moberg 1971 Spiritual Well-being Spiritual Well-being Spiritual Well-being 1971 Spiritual Well-being Spiritual Well-being 1972 NICA Spiritual Well-being Spiritual Well-being Spiritual Well-being 1981 1995 National 50
Symposium on Spiritual & Ethical Value System Concerns The Whole Aging Person: Wellness, Health Promotion, and Spirituality 1971 Spiritual Well-being Spiritual Well-being Spiritual Well-being 3-2-2 Spiritual Well-being Spiritual Well-being Spiritual Well-being MEDLINE AGELINE Spiritual Well-being Spiritual Well-being Spiritual Spiritual Moberg, 1978b 1970 Religious Spiritual Moberg, 1979a b, 1984 Spiritual Spiritual Well-being Scale Ellison, 1983Spiritual Well-being 2 1 Religious Well-being 2 Existential Well-being Spiritual Well-being Bufford, et al, 1991: Fehring, et al, 1987 Spiritual Well-being Holland, et al, 1999: Baider, et al, 1999 1970 51
hospice cure Holistic Medicine total pain Spiritual Saunders, 1978 1970 Spiritual Spiritual Well-being Body-Mind-Spirit Watson, 1985;, 1974 Spiritual Spiritual, 2001 primary care Spiritual Well-being Ruffing-Rahal, 1984Brooke, 1987Foley, et al, 1998 Spiritual Well-being Hungelmann 198565-85 31 Spiritual Well-being 2 1 2 Spiritual Well-being Harmonious Interconnectedness JAREL Spiritual Well-being Scale Hungelmann, et al, 1996 MacKinlay2001 Spiritual spiritual themes of aging 4 Leetun1996 Wellness Spirituality Protocol Spiritual Well-being 4 52
53 Spiritual Well-being Spiritual Well-being Wholeness Spiritual Well-being 1997Spiritual Well-being Spiritual Well-being
54 4 4-1 30 4 5 2000 9 75 65 75 New Elder Citizen 2001 5 1 30 10 3 2002 3 8 1
60 2001 92 1 30 2001 8 4-2 4-2 2 345 6 2 51 22 7 21 101 24 9 1 1 35 27 13 6 20 66 78.2 78.9 77.8 86.7 80.1 55
3 56
4 5 57
6 58
4-3 1-101 1-51 135-228 52-73 229-243 74-80 244-260 81-101 261-274 59
4-4 4-4-1 51 1-51pp.135-228 ---------------------------32 1310121617222931343639465051 45111415192025323738404344454748 --------------------------------------------------------------------------------21 381617182634464950 2691927303238404547 -----------------------------------------------------------------------------------19 1162931333436394150 111520273035404347 ---------------------------------------------------------------------------18 781217182224263449 25152027384347 ---------------------------------------------------------------------------------------17 1218222849 459141519273037434547 ---------------------------------------------------------------------------------15 16223139 256923273238424447 ------------------------------------------------------------------------------14 8121724335051 9142027324344 ----------------------------------------------------------------------------------------------------11 13718394149 5111315 60
-------------------------------------------------------------------10 50 6914213235404448 -------------------------------------------------------------------------------------9 1283649 49113544 -----------------------------------------------------------------------------------9 8 914202130434547 -------------------------------8 3102250 452738 --------------------------------------------------------------------------8 102231 1121324043 --------------------------------------------------------------------------------------------------6 122628333650 ----------------------------------------------------------------------------------------6 810122426 47 -------------------------------------------------------------------------------------------------------6 817183450 42 -----------------------------------------------------------------------------------------5 736 63538 -----------------------------------------------------------------------------------------5 11749 1325 61
62 -------------------------------------------------------------------------------------------5 3293951 25 ----------------------------------------------------------------------------------------4 16 63238 ----------------------------------------------------------4 810 620 --------------------------------------------------------------------------------3 2411 -----------------------------------------------------------------------------2 2330 --------------------------------------------------------------------------------------1 34 --------------------------------------------------------------------------------1 21 --------------------------------------------------------------------------------------------1 24 1 2
63 3 4 11 5 6 YWCA 7 8 78.2 51 11 9
64
65 4-4-2 52-73pp.229-243 ----------------------------------------------------------------------------------15 5355565966 57586163676869707173 ------------------10 5359 5758636768697173 ---------------8 55566166 68707173 ----------------------------------------------------------------------------------13 56 5457586063646768707173 --------------------------------------------------------------------------------------------------9 5355616272 60646570 ----------------------------------------------------------------------------6 5359 57676873 -------------------------------------------------------------------------------------------------------6 556266 656973 ------------------------------------------------------------------------------5 55 54606571
64 -------------------------------------------------------------------------------------------4 535961 ------------------------------------------------------------------4 54606573 -----------------------------------------------------------------------------------------------3 5559 73 --------------------------------------------------------------------------------3 577360 -----------------------------------------------------------------------------------------3 56 5463 ----------------------------------------------------------------------------------2 5767 ----------------------------------------------------------------------------2 5865 --------------------------------------------------------------------------------------------------1 60 --------------------------------------------------------------------------------------------------------1 71 -----------------------------------------------------------------------------------------------1 72 66
67 2 60 2 2 3 4 7 5 8
4-4-3 74-80pp.244-260 ----------------------------------------------------------------6 78 7475767980 ---------------------------------6 78 7475767980 ----------------------------------------------------------------------------------------------6 747576777980 ----------------------------------------------------------------------------------------5 7475767780 -------------------------------------------------------------------------------------------------5 78 74777980 -----------------------------------------------------------------------------------4 74757680 --------------------------------------------------------------------------------4 74757680 ---------------------------------------------------------------------------------------------------------3 78 7780 ---------------------------------------------------------------------------------------------------2 7475 ---------------------------------------------------------------------------------------------2 7580 68
69 --------------------------------------------------------------------------------------------------1 75 ---------------------------------------------------------------------------------------1 77 ------------------------------------------------------------------------------------------------1 77 -----------------------------------------------------------------------------------------------1 77 1 7 50 60 7 5 1 3
7 6 5 6 70
4-4-4 81-101pp.261-274 96 ------------------------------------------------------------------------------13 83848789909192939798100101 ---------------------------------------------------------------------------------------------11 96 8183879092939799100101 --------------------------------------------------------------------------------------10 96 828384858687929598 ------------------------------------------------------------------10 96 8182858789939599100 -------------------------------------------------------------------------------8 83899093959899100 ----------------------------------------------------------------------------------7 838486889598100 ------------------------------------------------------------------------------------------4 838495100 ---------------------------------------------------------------3 869398 ---------------------------------------------------------------------------------------3 899499 ---------------------------------------------------------------------------------------------------3 889599 71
8197 --------------------------------------------------2 --------------------------------------------------------------------------------------------2 9599 3 ------------------------------------------------------------------------------------------2 81101 -------------------------------------------------------------------------------------------2 8689 ---------------------------------------------------------------------------------2 91100 -----------------------------------------------------------------------------------1 82 -----------------------------------------------------------------------------------------------1 82 -----------------------------------------------------------------------------------------------1 100 ---------------------------------------------------------------------------1 101 ------------------------------------------------------------------------1 97 72
73 1 70-80 2 3 4 1 5 6
74 4-5 4-4 4 3 4 3
75 5
76 1 1
77 6 1 3 3 7 2 4 2 5 6 1 2 2
4-6 4-4 4-5 4-6-1 4-6-2 4-6-3 4-6-4 4-6-1 79 22 -------------------------------------------------------------------------12 335456638485868792959698 --------------------------------------------------------3 345383 ---------------------------------------------------------------2 4361 ---------------------------------------------------------------------------3 669097 ---------------------------------------------------1 72 ------------------------------------------------------------1 82 -------------------------------------------------------------------------------3 333443 ----------------------------------------------------------------7 53545661636672 78
79 ----------------------------------------------------------------------------0 ----------------------------------------------------------------------12 828384858687909295969798 4-6-2 1 ---------------------------45 ---------------------------32 ------------------27 ---------------------------15 ------------------13 ----------------------9 -------------------8 -------------------7 ----------------------------6 -------------------4 ----------------------------4 -------------------------4
---------------------------------------------------------------------------19 1249111213172125262833343536444950 ------------------------------------------16 52535557585960616264676869707273 ---------------------------------------------------------------2 7879 ---------------------------------------------------------------8 83848689939598100 ----------------------------------------------------------------------------27 3451011121415161719202225282931343637 39404344464748 --------------------------------------------2 6566 -----------------------------------------------------------------2 7780 ------------------------------------------------------------------1 82 -------------------------------------------------------------------------------4 692140 ----------------------------------------------1 65 -------------------------------------------------------------------7 74757677787980 ------------------------------------------------------------------14 818284878990919293969798100101 -------------------------------------------------------------------------------15 235162223273132383940444748 -------------------------------------------------------------------------------13 1357111315183941454950 80
535758596367697073 -----------------------------------------------9 --------------------------------------------------------------------------------8 812142022273047 --------------------------------------------------------------------------------2 842 ------------------------------------------------1 71 -------------------------------------------------------------------2 7780 --------------------------------------------------------------------2 8899 --------------------------------------------------------------------------------4 2242730 -----------------------------------------------1 54 --------------------------------------------------------------------1 99 --------------------------------------------------------------------------------4 6163238 -----------------------------------------------1 67 --------------------------------------------------------------------1 80 --------------------------------------------------------------------1 9499 81
82 ----------------------------------------------------------------------------------2 2651 --------------------------------------------------2 5671 4-6-3 1 2 6 6 6 8 8 8 12 13 14 16
83 16 17 17 17 18 19 21 25 2 27 27 1 1 28 1 1 1 30 32 32 34 35 36 38
84 40 40 42 45 45 46 46 49 50 52 2 1 53 54 55 55 57 57 57 58 59 2 59 60 61
85 63 1 67 67 67 68 69 70 71 73 74 75 75 2 5 76 77 77 79 2 79
86 3 81 82 83 86 86 87 87 4 88 89 89 90 90 92 92 4 2 93 93 93 94 95 96
87 97 97 98 99 99 99 99 100 101 20 7 8 9 24 21 75 23 28 1 29 30 20 33 33 34
88 35 35 35 36 36 40 41 44 44 45 48 49 50 50 51 52 53 53 3 64 55 55 57 57 1 57
89 57 58 58 59 59 2 59 61 62 64 64 68 70 71 71 72 73 1 2 73 73 74 74 74 75
90 76 76 76 76 76 I m OK, You re OK. 77 80 81 81 83 84 86 89 89 90 90 1 93 95 95 96 3 1 2 1 1 1
91 98 99 100 2 5 5 8 YWCA 15 9 7-8 10 11 11 12 15 15 22 24 25 27 29 30 31 37 39
92 42 43 20 43 47 51 55 55 61 70 71 91 100 3
93 4 5 5 9 12 12 13 14 15 15 1 16 17 18 19 22 25 27 29 30 37
94 39 43 44 44 45 47 48 49 51 60 72 75 75 101 16 1
95 2 5 6 7 8 8 9 10 15 15 17 18 22 24 26 27 32 34 43 47
96 49 54 60 65 65 71 65 74 74 80 95 95 99
4-6-4 1-101 1 ---------------------------------------------------------48 ------44 ------------------------------------------------------------39 ------------------------------------------------------------------31 ------------------------------------------------28 ---------------------------------------------------------------27 ---------------------------------------------------------------23 ---------------------------------------------------------------------------22 ---------------------------------------------------------------------20 ---------------------------------19 ---------------------------------------------------------------16 ------------------------------------------------------------------14 ---------------------------------------------------------------------------------13 ---------------------------------------------------------------------10 ----------------------------------------------------------------9 -----------------------------------------------------------------------------------8 --------------------------------------------------------------------6 --------------------------------------------------------------------------5 -----------------------------------------------------------------------4 ---------------------------------------------------------------------------3 4-6-2 1 97
98
99 4-7 4 101 22
100
101 5 4 Care of death and dying 5-1 31 1967 Saunders1978 Care Holistic Medicine On Death and Dying, 1971 Care of Death and Dying, 1991
1981 1984 1993 105 1971 2002 8 1 1970 1973 OCDP(the Organized Care of the Dying Patient) 19771974 1989 1977 19851978 2001 Spiritual Saunders1988 Spiritual Spiritual Pain4 total ppain Spiritual Saunders 1988Spiritual, 1994 Spiritual the need for meaning and purpose in life the need to give love the need to receive love the need for hope and creativity Highfield, et al, 1983search for meaningsense of forgiveness need for love need for hope 102
103 religious Schoebeck, 1994 Spiritual Spiritual Spiritual, 2001 Saunders, 1988 1996 Spiritual Spiritual 1977 Spiritual, 2000
104 5-2 4 5-1 Spiritual 4 Spiritual 1998 8 2 32 A, B, C, D V 5-3 7
105 5-4 A A-199/05/19 A1 A2 V A3 V A A4 A5 V A6 V A7 V A8 A-299/05/31 A9 V A A10 A11 A12 A13 A-399/06/10 A V A14 A15 85
A16 V A17 V A18 V A A19 A20 V A21 A22 A23 A24 A-499/06/29 A25 A26 A A E A27 A28 E E A29 E A30 V A A31 V A32 A33 A-599/11/25 A35 V A36 V A 106
A37 V 107
5-5 B 89 B B-199/05/19 B1 V B2 V B3 V B4 B5 V B6 B-299/05/21 B B7 V B8 V B9 V B10 V B11 V B B12 B13 F B B14 F B-399/05/24 B15 108
109 V B16 B17 B-499/06/23 B V B18 V B B B19 V B20 B21 V B22 V B23 V B24 B-599/07/08 B25 B26 V B27 B28 V B-699/07/08 B29 V B30 V B31
110 V B32 V B33 B-799/07/12 B34 V B35 V B36 V B37 B38 V B39 V B40
111 5-6 C C-199/05/28 C C1 V C-299/05/31 C2 V C3 C-399/06/04 C4 C5 V C6 V C7 V C8 C-499/06/11 C9 C10 85
112 V C11 C12 V C13 C14 V C15 C V C16 V C17 V C18 V C19 V C-599/06/13 C20 G V C21 C22 C-699/06/16 C G C23
113 V C24 C C C25 V C26 C-799/06/24 C27 V C28 V C-899/07/08 C 2 2 2 C29 V C30 1 C-999/07/10 C31 C32 V C33 C-1099/07/12 C34 V C35 V C36
C-1199/07/19 C C37 are the world V We are the world C C38 C394 V C C40 V C41 C-1299/08/02 C V C C42 V 11 V C43 V C44 C-1399/08/18 V C45 C46 V C47 114
115 V C48 V C49 V C C50 C51 C52 V C53 45 V C54 C-1499/08/24 C55 V C56 C-1599/08/29 C57 V C58 C59
116 5-7 D D-199/03/26 D D1 V D2 D3 V D4 D5 V D6 D7 D-299/03/26 D8 V D9 V D10 2 D11 V D12 15-6 10 D13 D14 V D15 V 63
117 D16 D17 V D18 D19 D20 V D21 D-399/3/29 D D V D22 D23 V D D D D D D D24 D25 V D26 V D27 D28 2
5-8 4 A A A9 A30 A13, A22 A A4, A11 A3 A5 A6, A7 A A16, A17, A20 A36 A8 A20, A26 B B B6, B12, B17 B7, B8 B23 B B9, B40 B-1, B-2 B B40 B-4B18, B25, B26 B B5, B10, B14, B29 B28, B35, B36 118
C C C6, C15 C2, C29, C31, C46 C32 C26C C-12, C-14, C-15 C-12 C-6 C C C44 C55 C59 C C-1,C-3 C-7 C1 C3, C4 C7, C8, C21, C22 C19, C23 C11, C12, C17, C28 C39-41 C C 3 1 C-7 2 C-8 C-12 C-10) 3 C-13 C50, C51, C57, C58 C52, C53 D D 3 D5, D6, D27 D11, D28 D D2, D3, D13, D26 D7 D15 D22 D25 D20 119
120 D7 D D D12, D24 D D
121 5-9 5-9-1 Spiritual 5-4 5-55-65-7 ABCD A A4 A5B B2 B23C C29 C31D D8 15-6 10 D12 D14 D15 Spiritual Saunders, 1988 5-9-2 Spiritual A BCD A
122 B 3 C C D D D 1997 Spiritual Spiritual Spiritual, 1997 Spiritual
123 6 6-1 6-1-1 4 5 1 5 5 6-2-2 6-1-3
124 1
125 4-6-3 4-4-2
126 6-1-2 4 5 4 1999 Spritual Saunders, 1988
127 82 6 23
128 6-2 6-2-1 5 1 53 57 100 6-2-2 1980 1989,1989 1 57 71
129 63 58 93 6-2-3 6-1-1 5, 2001 57 60 71 81 99 78 99 80 78
130 6-2-4, 19992-3-2, 1999 6-1-1 55 55 55 6-2-5
131
6-3 Spiritual Well-being Spiritual Well-being 6-1-1 Spiritual Well-being 2 Hungelmann1985 65-85 31 Spiritual Well-being Spiritual Well-being 2 Spiritual Well-being Harmonious Interconnectedness Spiritual Well-being MacKinlay, 2001; Leetun, 19963-2-3 Spiritual Well-being Hungelmann Spiritual Well-being 2 (Harmonious Interconnectedness) ( ) Ultimate Others (GodLife Principle) Past (Self) (Present) Future OthersNature Hungelmann, et al., 1985 132
133 Spiritual Well-being 2 Spiritual Well-being Spiritual Well-being Hungelmann 6-2-2 Spiritual Well-being Spiritual Well-being 3-2-3 Spiritual Well-being Spiritual Well-being, 2002
134 6-4 6-1-1 5
135 1-51 pp.135-228 52-73 pp.229-24374-80 pp.244-260 81-100 pp.261-274 A-D 5 5-45-55-65-7 1-51 1 52 1998 1 3 2002 9 2 16 2 1 150 71
136 E 2 40 74
137 2 60 48 62 59 60 1972 30 3 2 60 79 80 82
138 2 60 1805 2000 2002 1 4.5.6 22 3 1 1 2
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140
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147 8 4 2 2 OK 4 81
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151 100 50 10 20 78
152 1 1 21 1 2 5 10 45 2 20-30 39 4
153 1 7-8 11 1977 50 3 1981 3 79
154 1 1 1 75 79 20 3 9 5 1999 1999 4 1 1 2 2 2
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156 5 1 4 4 1950 1 5 30
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171 2 80 54 2 28 10 30 10 3 13.5 2 170 2
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173 68 6 8 10 10 19 2-3
174 7 6 75 50 70 22 3 6 13 15 2 1971 9 20 1992 5 2 84
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189 3 1 1 1 80 31 78
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203 38 10 61 8 3 72
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206 40 2 7 24 90
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227 10 62 2 3 11 1 1 1 12 1 3
228 1 80 1 11 1 1 10 9
229 52-73 52 53 2 1 2 1 1 15 15 54 84 75 84
230 55 2 1 3 64 84 2 10 2-3 68
231 2 56 82
232 4 4 300 82 85 3 57 83
233 1 7 1 1 5 3 14 20 60 25 6 58 77
234 10 59 3 3 2 60 72 91
235 90 61 4 50 40 68
236 62 2 64 45 77
237 63 72 64 65 88 80 85
238 3 27 60 3 60-79 66 73
239 67 1 6 3 68 60 78 67
240 69 70 6 9 12 2 84 73
241 20 30 50 3 6 71 8 15 20 60 70 3 3 52 48 60 84 84 84 85
242 23 72 48 48 2 74
243 73 4 6 1 2 25-6 88
244 74-80 74 7 3 10 60 2 9 10 10 3-4 1 80 70 70 80 1 81
245 90 1 22 22-24
246 ABC 50 A Jack and Betty 23 1 50 1 5 2 24 3 1 40 43 50 3 5 1 2 12
247 75 4 3 1 3 1 3 1 1 1 75 8 3 23 10 17 83
248 10 5 1 7 80 1 1 1 50 50 50 1 2
249 10 7 178 3 1
250 80 76 65 50 1 60 30 3 71
251 23 30 65 35 14-5 60 65 65 2 3
252 35 2 14 1 2
253 2 5 77 I m OK, You re OK. 1 3 79
254 78 A 79B B 10 2 A 1 A B A A A A 71 75
255 A A A A 56 A A A A
256 A A B B A A B 2 1 A B A 70 2 40 B B
257 A A B 1 20 2 A 80 29 5 1 17 48 23 2 25 85
258 65 60 4 2 40 47 56 45 4 1 1 1 100 6 49 5 1 23 3 2 6 7 77
259 14
260 47 1 24
261 81-101 81 1 7 82 50 1 72 10 2-3 84 83
262 83 5 2 3 1 88
263 84 40 85 3 2 94 92
264 86 87 80 83
265 88 4 30 1 89 84 94
266 3 94 94 4 2 30 2 60
267 5 90 16 17 27 89
268 91 92 93 4 2 55 1 73 84 89
269 2 94 95 30-40 89 88
270 96 97 98 90 9 91 44 77 92 90
271 3 1 2 1 1 1 8 7 74 60 60 70 90 99 6 90
272 20 1 100 1 1 3 7 7 2 8 3 10 91
273 4 2 90 12 91 101 88
274
1 Spiritual Well-being 2 The American Journal of Bioethics 200111 Chamber2001 The Fiction of Bioethics: A Précis 40-62 3 19451999 4 1970817 7 5 1964 146-160 6 1983 309-333 7 1989 337-353 8 1992, 1993, 1997 9 URL http://www8.cao.go.jp/kourei/ishiki/a_15.htm 10 1998 11 2001b, 2002b 1997 12 199721-50 1998 37-54 13 19991-14 14 1997171-186 1998 55-81 15 199883-98 1999 15-54 16 199753-115 17 199975-86 18 199955-74 19 199899-119 20 1997117-134 1998 121-136 21 1997147-170 22 2001 23 1999 412 WHO 24 URL http://www.mhw.go.jp/shingi/s9904/txt/s0412-1_6.txt 275
25 Spiritual 26 23 1999917 Spiritual Pain, 1999, Spiritual Pain 34, 153-157 27 6, 2001 28 33-2-1 3-2-22002b89-98 29 Chaplain 30 20009 75 74 207020028 31 55-12002a191-208 32 19992000197-2132002c2-15 2002d1-5 276
, 1965, 3, 68-74., 1981, 14, 36-48., 2001,., 1997,., 2000, Spiritual QOL 2(2), 44-52., 1992, 75 (1), 106-111., 1988, 10(2), 243-254., 1989, 24(4), 424-439., 1992,., 2002,., 2000, 41, 31-45., 2001,, 169-177., 1999,., E. H.,, J. M.,, H. Q., 1997,., 2000, QOL, 25-36., 1997,., PIL, 1993,., 1999,., 1996, Spiritual Pain 8(9), 16-17., 2001,., 1996, 6 2, 29-43., 1994,., 1999,., 1999,. 277
, 1977,., 1998,., 1993,., 1986,., 1985,, 270-273., 1980,., 1981, PIL 3, 96-110., 1968,., 1989,., 1997, 38(2), 97-118., 1973,.,, 1999,., 1996, 87(3), 95-111., 1989,, 337-353., 1999,., 1987,., 1995, 1995 BIOETHICS NETWORK19, 3-4., 2000,.,, 1971,., 2001, 11(1), 71-77., 2000,.,, 2001,., B. G.,, A. L., 1988,., 2001,, 215-241., 1998,. 278
,, 1994,.,,., 1994, 6., 1988,., 1991, 21., 1996,., 2001,., 2002,., 1997,., 1998,., 1999,., 2000,., 1989, NHK., 1981a, PGC 3, 83-95., 1981b, 17, 36-49, 1982, 4, 142-154., 1983, 2 5, 129-142., 1992a, 35, 3-9., 1992b, 75(12), 62-67, 1993,, 211-218., 2002, 8, 48-70., 1989a, 11, 99-115., 1989b, PGC 29, 64-74 279
, 1990, 12, 102-116., 1992,., 1993,., 1995,., 1997, 2., 1998,., 1993,., 1999,., 1999, EBM., 1976, 26, 83-100., 2000,, 1-8., 2001, 3(1), 39-47., 1974,., 1997,., 2000a, QOL 2(2), 3-8., 2000b,., 1991, 36, 82-90., 2001,., 2002,., 1981a, PGM (1) 3, 57-69., 1981b, PGM (2) 3, 70-82., 1986, 12, 117-126. 280
, 1990, 12, 117-126., 1985,., 1972,., 1983, 7, 309-333., 1986, 39 (12), 38-44., 1993,., 1987,., 2001, () 2, 131-136.,, 1997, 7(5), 349-367.,,, 1990,., 2002, 15(1), 23-30., 1999,, 114-117., 1964, 8, 146-160., 2001,., 2001,, 206-214., 1999, 69, 109-118., 2001,., 1989, 9(2), 21-28., 1990, PIL NIIGATA Educational Psychologist7, 19-25., 1984, 20, 46-58., 2000, WHO 10(2), 90-93., 1999, WHO BIOETHICS NETWORK29, 11. 281
, 1999,., 2000, 9, 197-213., 2002a,, 191-208., 2002b, Spiritual Well-being 11, 89-98., 2002c, 43, 2-15., 2002d, 53, 1-5., 2002e, Bioethics Study Network1(2), 6-5., 2002f, BIOETHICS NETWORK34, 21., 2000, 11, 58-63., 2001, 12, 91-96., 2002, Spiritual Well-being 7(1), 47-52.,, 1991,.,, 1974,,., 1993,., 1987,., 2001a,., 2001b,., 2002a,., 2002b, 5., 1996,., 2000, 2(1), 87-92., 1996, QOL QOLWHO QOL1(1), 11-15. 282
, 1999, QOL WHOQOL9(1), 123-131., 1995,., 1984,., 2001, 7, 4-14., 1998,., 1994,., 1990, 32, 3-11, 1999,., 1998,., 2000, 41, 47-64., 1984,.,, 1991,,.,,, 1998,., 1994,., 1996,., 1997,., 1991,., 1992,., 2001,.,,, 1997,., 1999,, 131-168., 1983,., 1984,, 58-96., 2002, QOL 8, 71-89., 2000,., 1995,., 1988, 6., 2000, 36, 95-110. 283
., 1989, 29, 75-85, 1967,.,, 1982,.,, 1999,,.,, 2000, 1.,, 2001, 2., 1981,., 1984, 5 (1), 101-118., 1988, 28, 3-18, 1979, 11, 15-31, 1988, 27, 3-13, 1989, 30, 3-16,,, 1997,.,, 1992, QOLQOLOT 26, 4-8.,, 2001,., 1990,., 1988, 10(2), 255-270., 1971,., 1998, 7, 1-12., 2002, A13A, 35-42., 2000, 41, 15-29., 2001,, 91-110., 1981,. 284
, 2001, 3(4), 80-92., 1998,., 2000,., 2001, QOL 48 (4), 12-19., 1999, TBS., 1981, 14, 22-35, 2000, 41, 3-13, 2001,, 25-52. 285
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