The evaluation and management of interstitial lung disease is an evolving topic where clinicians are often left without a clear “right” answer. We will use the popular pro/con debate format to engage the audience in four areas of current controversy in the field including whether patients with scleroderma should undergo lung transplantation, if elderly patients with idiopathic pulmonary fibrosis (IPF) should be treated with anti-fibrotic therapy, whether patients with rapidly progressive interstitial lung disease should be treated with extracorporeal membrane oxygenation (ECMO), and whether interstitial pneumonia with autoimmune features (IPAF) is a distinct clinical entity and should be treated as such.