Values-based practice (VBP) is a tool to deal with diversity of values in the process of decision-making in health care services. It is assumed to be a skills-based instrument to balance legitimately contrasting values. It remains, however, unclear, how the different values can be judged and weighted to the satisfaction of all involved actors based exclusively on exercise of technical skills and without reference to a set of core values with a global character which are not contingent on the particularities either of the context or of the values implicated in decision-making. The present analytical endeavour is based on a navigation in thorny aspects of decision-making in everyday clinical practice in intercultural settings, which are characterized by the limited common ground of shared values. It is focused on obstacles of VBP implementation that arise from casting doubt on the medical nature of patient’s suffering, from power asymmetries, from the uncompromisable insistence on the rightness/importance of actor’s own beliefs/views, from arbitrary treatment of the different values, as well as from constraints of VBP actors’ autonomy. VBP implementation implicitly or less implicitly presupposes a core set of values of a higher order compared to those in play in decision-making (meta-values). The talk will illustrate the role of reciprocity, mutual regard/dedication to amenability/compromise, illness insight, egalitarian attitude and autonomy as meta-values in VBP implementation. Such insights in the value premises of VBP procedures clarify the substantial nature of VBP and facilitate VBP implementation in intercultural settings.