Decisions to leave home. What will the neighbors say?

This paper discusses two of the problems encountered when a decision not to institutionalize patients is made. When patient, physician, and family jointly decide to forego institutionalization, the family often subconsciously fears communal censure if it fails to call for help when the end is near. This may, at the last moment, prompt some families to call emergency teams and thwart the original purpose of the decision. Instances in which a previous decision not to institutionalize is justifiably interrupted, are discussed. Such an interruption does not necessarily foil the original plan if it is transient and one to provide comfort. An interactive model in which patients, health-care workers, families, and the community share is used. It is suggested that when a decision not to institutionalize is well-discussed, compassionately made, and carefully implemented, it may itself tend to reshape the communal ethos. As a result, communities, rather than expecting reflex action, are more prone to examine the appropriateness of institutionalization or emergency measures in particular cases and under particular circumstances.