To the Editor: Dr. Askin's letter raises two issues related to the pediatrician's billing for services on the occasion of an infant's death. These are: (1) the meaning of being billed, and whether this represents "an extra burden... added to their sorrow," and (2) the parents who need to project their anger about their loss onto the physician. Although no definitive research has been done in this area and opinion of practitioners varies, there are several principles of psychiatric knowledge which are relevant in the decision about sending a statement at the time of a child's death.
Psychiatric knowledge about the emotional significance of receiving a bill and making payment for services indicates that request for appropriate payment is an expression of the physician's positive evaluation of his services and a positive evaluation of the patient. In the situation of an infant's death, it has the meaning of allowing the