厚生労働省の「介護職員等によるたんの吸引等の実施のための制度の在り方に関する検討会」（座長＝大島伸一・独立行政法人国立長寿医療研究センター総長）は12月13日、6回目の会合を開き、厚労省が示した中間まとめ案を大筋で了承した。介護職員が実施できる医行為の範囲や、実施できる施設などが盛り込まれている。これを受け厚労省では 関連法案を来年の通常国会に提出する方針。
■医行為は介護福祉士の「業務」
中間まとめでは、介護職員らが実施できる医行為の範囲として、たんの吸引（口腔内、鼻腔内、気管カニューレ内部）と経管栄養（胃ろう、腸ろう、経鼻経管栄養）を提示。医行為を実施する人としては、介護福祉士をはじめとした介護職員のほか、保育所の保育士や特別支援学校などの教職員を挙げている。
特に介護福祉士については、「業務」としてたんの吸引などを実施できるよう、養成カリキュラムに関連内容を追加すると明記。既に介護福祉士の資格を取得している人については、追加研修を修了することで実施できるとしている。また、介護福祉士以外の介護職員らも研修を修了すれば、一定の条件下で実施できる。
■研修は「可能な限り施設・在宅等の現場で」
研修を実施する場所としては、「可能な限り施設・在宅等の現場で行う」としている。研修の大まかな内容については、不特定多数の人に医行為を実施する場合と、重度障害者などの施設の職員や特別支援学校などにおける教職員など、特定の人を対象とする場合とを区別。特定の人を対象とする場合は、実地研修を重視した研修体系とするとされている。ただ、具体的な研修内容については、実施中の「介護職員によるたんの吸引等の試行事業」の結果を踏まえ、検討するとしている。
■医療機関は実施の対象外に
たんの吸引などを行う条件については、「一定のニーズはあるが、看護職員だけでは十分なケアができない施設、在宅などとして、医師・看護職員と介護職員らの適切な連携・協働が確保されていること」と明記。介護職員らがたんの吸引などを実施できるのは、▽介護関係施設（特別養護老人ホーム、老人保健施設、グループホーム、有料老人ホーム、通所介護、短期入所生活介護など）▽障害者支援施設など（通所施設およびケアホームなど）▽在宅（訪問介護、重度訪問介護など）▽特別支援学校―となっており、この中で一定の基準を満たした施設や事業所を都道府県が登録し、指導・監督する。医療機関については、対象外となった。
■実施時期は「2012年度を目指す」
制度の実施時期としては、「2012年度の実施を目指す」と明記された。現在、一定の条件下でたんの吸引などを実施している人に対しては、必要な経過措置を設けることを付記。介護福祉士についても、養成課程の整備や新たなカリキュラムでの養成期間などを踏まえた実施時期とするとされた。なお、介護職員らによるたんの吸引などの行為については、社会福祉士及び介護福祉士法などに位置付けられるとしている。
■医行為をめぐる議論が再燃
会合では、構成員の三上裕司氏（日本医師会常任理事）が、たんの吸引と経管栄養を介護福祉士の業務として位置付けるのではなく、医行為から外すべきと改めて主張した。これに対し、多くの構成員からは反対意見が続出。議論は平行線をたどった。結局、たんの吸引や経管栄養について、医行為ではない行為とすべきとする意見があった点を付記することで、中間まとめ案は了承された。
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