In his best-selling The Seven Habits of Highly Effective People, Stephen Covey urges readers to seek "win-win" outcomes. In health care, we have too often approached ethical problems as win-lose affairs. Some party's values—those of the doctor, the hospital, the patient, or family—should prevail while other parties accept the subordination of their own values.

The tendency to view problems as dilemmas in which a universally valid principle must hold sway has reflected and reinforced this mindset. Fortunately, most "dilemmas" prove negotiable because the affected parties eventually seek a workable solution rather than an all-or-nothing enactment of their values. Unfortunately, dilemmas involving religious and cultural differences have often been among the most polarizing and intractable. In emotional situations the win-lose mentality is never far away.

One way to read this Bulletin is to see its stories of new immigrants and health care as real-life illustrations of the need for a win-win moral mindset and examples of the fruits such a mindset can yield. As these articles show, distinctive beliefs and practices of post-1965, mostly non-European arrivals challenge a dominant health care culture not simply to accommodate to "their" ways, but to rethink its universalizing assumptions.

Phenomena that moderns distinguish as "religion" and "culture" have flowed together, often for thousands of years, to form many immigrants' health beliefs and practices. Ironically, in a new cultural setting these may seem naive to health care personnel. With experience, many practitioners discover the need not for mere tolerance—or standoffish "respect"—but for the kind of careful listening and attentive observation that yield understanding and, eventually, informed appreciation. What was at first foreign stimulates deeper reflection and a richer sense of the possible.

Immigrants have always modeled new possibilities, whether by necessity or by design. Responding to human need in their communities and beyond, immigrants from Jewish, Catholic, and Protestant traditions established hospitals that reflected their faith in allopathic medicine as well as their God.

New immigrant groups often take a both/and approach to modern medicine. As our authors point out, Haitians may turn to Vodoun as well as biomedicine and Hmong may consult both doctors and shamans, much as some Latino immigrants may see a curandero along with a physician. As they press the biomedical paradigm to widen its own horizons, new immigrants show health care old-timers a thing or two about both/and and win-win.