Home oxygen therapy (HOT) is prescribed to patients with pulmonary dysfunction to improve survival and quality of life. However, ignition of oxygen can lead to burns with significant morbidity and mortality. Providers who routinely treat this patient population face an ethical issue: balancing the obligation to provide beneficial treatment to a patient with the responsibility to protect that patient from suffering avoidable burn injuries. A thorough review was conducted to assess the literature regarding ethical considerations involved in managing patients who have been burned while smoking on HOT and who continue to smoke. Various aspects of this problem and potential approaches to address it were analyzed with respect to 4 core ethical principles of health care: beneficence, nonmaleficence, autonomy, and justice. For patients who repeatedly present with burns acquired secondary to smoking while on oxygen, the authors consider it ethically unacceptable to withhold standard-of-care intervention for acute burns because refusal to treat acute burns conflicts with all 4 ethical principles. A preventive strategy would encourage a more judicious prescription of HOT, supporting the principles of nonmaleficence and beneficence. Additional preventive strategies include upstream solutions such as longitudinal patient education about smoking cessation and the risks of smoking on HOT. Physicians are tasked with the responsibility of both providing optimal care for this patient population and preventing future burn injuries. They may be able to address this challenging situation by thinking more critically about potential solutions while bearing in mind key ethical considerations and obligations.