Day 017 - 25 Jul 94 - Page 63


     
     1   Q.   To what extent is the input of the family of the patient
              important in the management of the illness?
     2        A.  I think it is very important because they are
              providing support.  They can also, hopefully, help the
     3        patient to be positive.  Sometimes the treatments that we
              give are quite tough, and it easy for patients to feel
     4        down and lose direction at times; so the family is
              extremely important in providing that support, helping
     5        them to remain positive throughout their treatment.
 
     6   Q.   May I ask you this question to which by now perhaps the
              answer is obvious.  What view do you take or would you
     7        take of this hypothetical situation, that a patient had
              been misled into supposing that they had colorectal
     8        cancer, let us say, or cancer of the colon, on account of
              the diet that they had been eating over the last 10, 15 or
     9        20 years?
              A.  Well, I mean, I think that would be a dreadful
    10        situation for people to actually be told that sort of
              information.  For example, I have already mentioned this
    11        question of guilt and its deleterious effect on the
              patient and his potential response to treatment.
    12
              There is no scientific evidence to support such an
    13        argument.  It can only have an adverse effect on patients
              and their outcome.  Patients are subject to all sorts of
    14        stress and, I think, you know, unless one is actually
              looking after people, it is sometimes difficult to
    15        actually fully appreciate the stresses that they are
              subjected to, and this sort of thing, I think, is to be
    16        deplored.
 
    17   Q.   Can I take it one stage further?  Do you have young people
              as patients?
    18        A.  Yes, we have children in our department.
 
    19   Q.   With cancer of colon or the rectum?
              A.  No.  Cancer of the colon tends to occur in somewhat
    20        older people but, you know, one gets it in the 20s, 30s or
              40s, so relatively young people.
    21
         Q.   Let us take somebody in their late 20s, early 30s,
    22        something like that, with parents?  You told us that the
              input of the family in management of the illness is
    23        important?
              A.  Indeed, yes.
    24
         Q.   In your view, as a person who treats patients with these
    25        conditions, would it matter if the parents believed that
              it is their fault that the child had the cancer because of 
    26        the diet they had been giving it over the last year? 
              A.  Well, I mean, again I think that would be a dreadful 
    27        state of affairs.  As I have already indicated, the family
              is of tremendous importance in giving support to patients
    28        going through treatment, and for them to have this added
              concern of their guilt as well as trying to get the
    29        patient through the patient's guilt, I think again my
              comment is that it would be deplorable.
    30
         MR. RAMPTON:  Thank you, Dr. Arnott.  My Lord, those are all

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