An effective method is urgently needed for teaching applied medical ethics to both medical and nonmedical students in Japan. Education has become necessary because recent medical advances, such as organ transplantation from brain-dead donors, has complicated medicoethical decision making for patients, their families, physicians, and other medical staff. In 1998 and 1999, I introduced an ethical training program for nursing students and nonmedical university students using a case study from H. Brody's book Ethical Decisions in Medicine, which I had helped revise. I discussed the case of a 10-year-old brain-dead boy. Teaching with the case study demonstrated that both nursing students and nonmedical students often interpreted ambivalently the meaning and treatment of brain death as used in this case study. When asked to play the role of the physician, most students, while assenting to the definition of brain death as a human death, chose not to decide whether to stop artificial respiration but instead felt that the boy's parents had the right to decide.

Clinical cases requiring bioethical thinking and decision-making have become more complex owing to advances in medical technology and changes in family relationships. In addition, members of medical staff are asked to acquire the ability to think in terms of bioethics. For training in such ability, the use of case studies is important and essential. For a medical ethics class we created 30 cases involving communication between patients and physicians, changes in family relationships, and advanced medical technology, such as genetic diagnosis and gene therapy. We asked all second-year medical students of the Osaka University Medical School to think about these 30 cases and answer questionnaires about bioethics. We believe the case-study method is effective for training students in the ability to think in terms of bioethics.