Researchers in international settings must continually examine cross-cultural ethical issues to ensure that their work is ethically sound. In this article, the authors discuss the process of ethical decision making in international nursing research. They draw on research in Ghana during 1999 involving HIV seropositive women to document this process. Referring to this experience, they argue that international research involving human beings must meet two related but distinct ethical tests: It must meet international ethical standards for the protection of human participants but, at the same time, acknowledge the ethical standards related to the institutional setting and cultural environment in which the research takes place.