A middle-aged person's involvement in making a decision about whether or not to institutionalize an aged parent whose physical and/or mental capacities have failed inevitably arouses intense feelings, memories, fantasies, and conflicts. Fantasies that equate putting the parent in a nursing home with abandonment and murder, as well as the narcissistic threat posed by seeing one's own future in a parent's deterioration, are common. The conflicts aroused may upset long-standing psychological balances. This paper explores ego, superego, id, and reality issues that are aroused as they were seen in the psychoanalysis and psychotherapy of several patients involved in making this decision. The importance of looking for the unique aspects of the conflicts set off in each individual facing this dilemma is stressed, as is the potential for countertransference responses.