Coburn D
Department of Behavioural Science, University of Toronto, Ontario, Canada.
J Manipulative Physiol Ther. 1991 Jan;14(1):14-21.
A number of researchers from Australia, Britain, the United States and Canada describe the twentieth century development of chiropractic in terms of increased official and public recognition "in exchange for" a narrowing of scope of practice claims. This process in Canada is briefly described and is illustrated by examining chiropractic's relationships with naturopathy, a broad scope of practice health occupation. It is shown that chiropractic in Canada first used naturopathy to try to expand its own scope of practice, but then quickly rejected any official connections with a broad scope naturopathy in a recent drive to gain state recognition for a chiropractic "purified" of its past all-inclusive claims, a drive which has been at least partially successful. Yet, this narrowing contradicts chiropractic's frequent claims to be a holistic health discipline and presents practical problems for chiropractic. While chiropractic is in the process of gaining official recognition under proposed health disciplines legislation in Ontario, it is faced with dilemmas produced by its contradictory claims to narrowing and to holism. At the same time, chiropractic, along with many other previously subordinate health occupations, seems to be in the process of replacing medical dominance with a broader, but perhaps just as authoritarian, regime of "professional dominance." Will success inevitably bring not only an implicit acknowledgement of the claims of orthodox medicine, but also a separation of chiropractors from patients, those whom chiropractors once made a unique claim to serve?
一些来自澳大利亚、英国、美国和加拿大的研究人员认为，整脊疗法在20世纪的发展表现为官方和公众认可度的提高，“作为交换”，其执业范围的主张却在缩小。本文简要描述了加拿大的这一过程，并通过考察整脊疗法与自然疗法（一种执业范围广泛的健康职业）的关系加以说明。研究表明，加拿大的整脊疗法起初利用自然疗法来试图扩大自身的执业范围，但后来在最近为获得官方认可而进行的努力中，迅速摒弃了与执业范围广泛的自然疗法的任何官方联系，这场努力旨在使整脊疗法摆脱过去包罗万象的主张，至少在一定程度上取得了成功。然而，这种范围的缩小与整脊疗法经常宣称的是一种整体健康学科相矛盾，并给整脊疗法带来了实际问题。在安大略省拟议的健康学科立法下，整脊疗法正处于获得官方认可的过程中，它面临着因缩小范围和整体论这两种相互矛盾的主张而产生的困境。与此同时，整脊疗法与许多其他以前处于从属地位的健康职业一样，似乎正在用一种更广泛但可能同样专制的“专业主导”制度取代医学主导地位。成功是否不可避免地不仅会隐含地承认正统医学的主张，还会使整脊治疗师与患者分离，而整脊治疗师曾一度声称要独特地服务于这些患者呢？
