The New Zealand Medical Association (NZMA) is reviewing its Code of Ethics. The current Code is predominantly an individual patient-focussed, doctor as independent practitioner and monocultural document, based substantially around the four principles of Beauchamp and Childress. This paper discusses the limitations of this approach and describes three groups who have developed ethical codes that depart substantially from the NZMA; the Public Health Association, The New Zealand Nurses Organisation (NZNO) and the Putaiora Writing Group "Guidelines for Maori Research Ethics". All of these put much greater emphasis on trusting relationships as a foundation for ethical behaviour, which the current NZMA Code of Ethics pays little attention towards. This paper argues that the emphasis on the universality of the four principles is incompatible with the development of trusting relationships with diverse individuals and groups and is a barrier to culturally competent practice, public health practice and collaborative interdisciplinary practice.