021 - Ethics Roundtable: Prescribing Controlled Substances in a Terminally Ill Patient With Suspected Substance Abuse Disorder and Opioid Agreement Violations

This is an interdisciplinary ethics roundtable centered on a terminal lung cancer patient suspected of diverting methadone and violating his controlled substance agreement. Various experts, including physicians, a lawyer, a chaplain, and a psychologist, evaluate the conflict between the duty to relieve suffering and the necessity of maintaining legal and professional boundaries. The contributors suggest strategies ranging from stricter monitoring and liquid formulations to involving social services to investigate potential exploitation. While some argue for immediate dismissal due to safety risks and illegal activity, others emphasize harm reduction and the moral imperative to avoid patient abandonment. Ultimately, the text highlights the complex challenge of managing refractory pain in patients with possible substance use disorders during end-of-life care.