Art therapy can be an effective way to focus on end of life issues with cancer patients facing imminent death. This viewpoint discusses ethical challenges in the treatment of a 63-year-old man with terminal lung cancer who was participating in short-term individual art therapy. Difficult issues that often surface in the final days of life may include greater need for trust, dependency on others, feelings of inadequacy, loss of control, and fear of death. The situation may present pertinent ethical dilemmas for the art therapist, which directly impact the choice of therapeutic intervention that best serves the interests of a dying client. (Contains 1 figure.)