This article explores the ethical tensions and dilemmas that arose for 2 U.S. social work students during an 8-month international clinical internship in northern Uganda. These students encountered cultural differences related to issues of confidentiality, autonomy, and self-determination. Student experiences were analyzed using the cultural orientation framework of collectivism. A strategy for reflecting on ethical dilemmas that arose is presented involving identification and exploration of the ethical dilemma, reflection on the dilemma in the context of culture and socioeconomic factors, development of culturally responsive and ethical interventions, and continued review and reflection. Such exploration of culturally based value differences is needed to increase social work students' cultural competence.