Quill and Cassel [1] stress that nonabandonment is one of physicians' central obligations that reflects a longitudinal commitment to the patient. In some situations, unfortunately, abandonment is beyond the control of the physician or the patient.

Abandonment is sometimes brought about by an institution. Take, for example, a patient who loses his job and no longer has health insurance or no longer belongs to a prepaid medical group through his employer and therefore no longer has access to a particular practitioner or facility. Even if the physician chooses to see this patient without remuneration, the health facility with which he or she is affiliated will often not show the same generosity. These ruptures can occur with little warning and little opportunity to prepare the patient.

I work in a Canadian military facility that until 1 January 1995 also cared for retired veterans and members of the military. With only 6 weeks' notice, these patients were informed that they could no longer obtain medical care at the hospital or visit their physicians who worked at the hospital. The feeling of mass abandonment was terrifying—these patients feared not only for the loss of their continuing care and their relationship with their usual physician but also feared for their future medical care.

In today's society, few patients pay directly for their medical care; most rely on a third party, be it insurance or a prepaid plan. Unfortunately, unless patients have direct control over the financial aspect of their medical care, institution-initiated abandonment will continue.

Disclaimer; These opinions are those of the author and do not necessarily represent those of the Department of National Defence, Canada.