The challenge of cultural and ethical pluralism to medical practice.

* "Culture" can be understood as the way in which people make sense of the world by deploying shared meanings, attitudes, assumptions and values. * Doctors will frequently encounter patients whose lives are guided by ethical systems and values that are different from their own. * Individuals may differ in their beliefs about decision-making, regardless of their cultural background. * Doctors should be willing to examine and test their own moral systems and cultural assumptions and be open to alternative traditions and beliefs. * Engaging with other cultures does not imply that all cultural norms should be accepted uncritically, as there may not always be room for compromise. * Failure to engage with issues of culture can erode the trust on which the doctor-patient relationship depends. * Tensions can only be resolved through rigorous attention to a person's story.