As a way to advance integration between traditional readings of the medical encounter and argumentation theory, this article conceptualizes the doctor–patient interaction as a form of info-suasive dialogue. Firstly, the article explores the relevance of argumentation in the medical encounter in connection with the process of informed consent. Secondly, it discloses the risks inherent to a lack of reconciliation of the dialectical and rhetorical components in the delivery of the doctor’s advice, as especially resulting from the less than ideal conditions (...) of the internal states of the doctor and the patient, and the lack of symmetry in their status. (shrink)

Premissary relevance is a property of arguments understood as speech act complexes. It is explicable in terms of the idea of a premise's lending support to a conclusion. Premissary relevance is a function of premises belonging to a set which authoritatively warrants an inference to a conclusion. An authoritative inference warrant will have associated with it a conditional proposition which is true— that is to say, which can be justified. The study of the Aristotelian doctrine of topoi or argument schemes (...) may contribute to the task of identifying authoritative warrants. (shrink)

Argumentation theory has much to offer our understanding of the doctor-patient relationship as it plays out in the context of seeking and obtaining consent to treatment. In order to harness the power of argumentation theory in this regard, I argue, it is necessary to take into account insights from the legal and bioethical dimensions of informed consent, and in particular to account for features of the interaction that make it psychologically complex: that there is a fundamental asymmetry of authority, power (...) and expertise between doctor and patient; that, given the potential for coercion, it is a challenge to preserve the interactive balance presumed by the requirement of informed consent; and finally that the necessary condition that patients be ‘competent to consent’ may undermine the requirement of respecting patient autonomy. I argue argumentation theory has the resources to deal with these challenges and expand our knowledge, and appreciation, of the informed consent interaction in health care. Keywords: argumentation theory, informed consent, doctor-patient interaction, competency to consent, autonomy, medical paternalism. (shrink)

Argumentation can play an important role in medical consultation. A doctor could, for instance, argue in support of a treatment advice to overcome a patient’s hesitance about it. In this argumentation, the doctor might explicitly present him- or herself as an authority, thereby presenting an argument by authority. Depending on the specific conditions under which the doctor advances such an argument, the doctor’s argument by authority can constitute a sound or a fallacious contribution to the discussion. In this paper, I (...) shall determine what the specific soundness conditions are that apply to a doctor’s argumentation by authority in medical consultation. Keywords: medical consultation, pragma-dialectical analysis, soundness condition, argument by authority, doctor-patient communication. (shrink)

This article is concerned with the reasons why sometimes good arguments in health communication leaflets fail to convince the targeted audience. As an illustrative example it uses the age-dependent eligibility of women in the Netherlands to receive routine breast cancer screening examinations: according to Dutch regulations women under 50 are ineligible for them. The present qualitative study rests on and complements three experimental studies on the persuasiveness of mammography information leaflets; it uses interviews to elucidate reasons why the arguments in (...) the health communication leaflets for the exclusion of women under 50 from routine mammographic screenings do not work. (shrink)

I argue that argumentation is not to be identified with (attempted) rational persuasion, because although rational persuasion appears to consist of arguments, some uses of arguments are not attempts at rational persuasion. However, the use of arguments in argumentative communication to try to persuade is one kind of attempt at rational persuasion. What makes it rational is that its informing ideal is to persuade on the basis of adequate grounds, grounds that make it reasonable and rational to accept the claim (...) at issue. (shrink)

This essay offers a start on sorting out the relationships of argumentation and persuasion by identifying two systematic ways in which definitions of argumentation differ, namely, their descriptions of the ends and of the means involved in argumentative discourse. Against that backdrop, the traditional “conviction-persuasion” distinction is reassessed. The essay argues that the traditional distinction correctly recognizes the difference between the end of influencing attitudes and that of influencing behavior—but that it misanalyzes the means of achieving the latter (by focusing (...) on emotional arousal) and that it mistakenly contrasts “rational” and “emotional” means of influence. The larger conclusion is that understanding the relationships of the phenomena of argumentation and persuasion will require close attention to characterizations of communicative ends and means. (shrink)

This paper throws some light on the nature of argumentation, its use and advantages, within the setting of doctor–patient interaction. It claims that argumentation can be used by doctors to offer patients reasons that work as ontological conditions for enhancing the decision making process, as well as to preserve the institutional nature of their relationship with patients. In support of these claims, selected arguments from real-life interactions are presented in the second part of the paper, and analysed by means of (...) a model of argumentation borrowed from classical rhetoric, and refined according to the modern orientation of the pragma-dialectic approach. (shrink)

Over the past decade, the ideal model of shared decision-making has been increasingly promoted as the preferred standard of doctor-patient communication in medical consultation. The model advocates a treatment decision-making process in which the doctor and his patient are considered coequal partners that carefully negotiate the treatment options available in order to ultimately reach a treatment decision that is mutually shared. Thereby, the model notably leaves room for—and stimulates—argumentative discussions to arise in the context of medical consultation. A paradigm example (...) of a discussion that often emerges between doctors and their patients concerns antibiotics as a method of treatment for what is presumed to be a viral infection. Whereas the doctor will generally not encourage treatment with antibiotics, patients oftentimes prefer the medicine to other methods of treatment. In this paper, two cases of such antibiotic-related discussions in consultation are studied using insights gained in the extended pragma-dialectical theory to argumentation. It is examined how patient and physician maneuver strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibrium between patient participation and evidence-based medication, while arguing a case for and against antibiotics respectively. (shrink)

This article reacts against the undesirable ideological separation between dialectical and rhetorical approaches to argumentative discourse. It argues that a sound evaluation of argumentation requires an analysis that reveals all aspects of the discourse pertinent to critical testing. To explain the rationale of the various moves made in the discourse and the strategic patterns behind them, not only the interlocutors' dialectical goals must be taken into account, but also their rhetorical goals. After explaining how rhetorical insight can be instrumental in (...) deepening and justifying a dialectical analysis, an integrated analysis is made of the rhetorical strategies that are brought to bear in an advertorial published by the oil company Shell. (shrink)

In this paper it is first investigated to what extent the institutional goal and basic principles of shared decision making are compatible with the aim and rules for critical discussion. Next, some techniques that doctors may use to present their own treatment preferences strategically in a shared decision making process are discussed and evaluated both from the perspective of the ideal of shared decision making and from that of critical discussion.