How far would you go in giving opiates to a patient with end-stage cancer? Would you go as far as giving enough to shorten his or her life if that's what it took to give relief?

"By this time our discussions regarding end-of-life care would have been made, including their philosophical implications. I would make sure that my patient understood that end-of-life care includes not a 'quantity' of life but a 'quality' of life, including the use of anything that I will give, even if it were to shorten his or her life. I feel everyone deserves merciful comfort during the last days of disease that is unarguably terminal, however it affects the timeline."

Don't be fooled by this question. It isn't about the opiate 'crisis' of overdose deaths or narcotic diversion. Also, it's not about euthanasia. It's about the patient and what's best for him or her. Think of opiates as any other medication, with a perspective on its side effects or adverse effects as it applies, individually, to your patient. Also, you need to include in your answer an appreciation for Advanced Directives (AD).

"At the appropriate time I would have a frank discussion with my patient for end-of-life care, which would include prolongation of life vs quality of life. Whatever I do with opiates, should they be needed, will have been discussed beforehand."