Medical ethics was traditionally not taught as a part of the formal medical curriculum. However, medical ethics has become a common feature of medical education in some Western countries because of the increased interest in bioethics since the 1970's. A growing number of Japanese medical schools are now teaching medical ethics in independent courses, therefore, the establishment of integrated teaching programs will become an important issue. The concept of vertical and horizontal integration, a recommended feature of medical ethics programs in the West, should also be applicable in Japan. Strategies are discussed regarding: 1) biological education and health education at junior and senior high schools; 2) liberal arts education for medical students; 3) clinical education; 4) postgraduate education and reeducation for medical teachers; and required core organization.

To investigate the status of ethics education in Japanese medical schools, a self-administered questionnaire was sent to all 80 medical schools in 1995. Sixty-four (80.0%) medical schools responded, of which 60 answered they offer or will offer courses in which medical ethics topics are taught. Most classes are compulsory and are held before bedside teaching begins. Nineteen medical schools have separete medical ethics courses, and the others have medical humanities courses in which medical ethics are taught as part of the course. The respondents rated “the physician's duty, ” “informed consent, ” and “patients' rights” as the three most important topics that should be taught to medical students.

We have used narrative approach to supplement the two usual methods of teaching biomedical ethics: the principlebased approach and the casuistic approach. Our experience suggested (1) although the learning of key principles is essential to medical ethics, the casuistic approach can be the more effective strategy than the principle-based approach for learning clinical moral reasoning and (2) that narrative approach can be the most effective learning strategy in humane medicine, especially in relativizing a student's moral views. By combining these three approaches, learning strategies in medical ethics can be refined.

We conducted a questionnaire survey on medical students' attitude on bioethics education. The survey was conducted at the beginning of bioethics courses for fifth-year students from 1997 through 1999. The results suggest that students who had relatively stronger interest in bioethics considered themselves to be “generalist-oriented doctors” rather than “specialist-oriented doctors” and were interested in nonmedical academic fields. Teaching of most bioethical issues was evaluated as not being sufficient for the students' level of interest. Many students thought that bioethics should be taught repeatedly throughout their medical education and that more time should be dedicated to case discussion.