In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, (...) in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient. (shrink)

This essay explores the role of informal logicand its application in the context of currentdebates regarding evidence-based medicine. This aim is achieved through a discussion ofthe goals and objectives of evidence-basedmedicine and a review of the criticisms raisedagainst evidence-based medicine. Thecontributions to informal logic by StephenToulmin and Douglas Walton are explicated andtheir relevance for evidence-based medicine isdiscussed in relation to a common clinicalscenario: hypertension management. This essayconcludes with a discussion on the relationshipbetween clinical reasoning, rationality, andevidence. It is argued that (...) informal logic hasthe virtue of bringing explicitness to the roleof evidence in clinical reasoning, and bringssensitivity to understanding the role ofdialogical context in the need for evidence inclinical decision making. (shrink)

This volume gives a theoretical account of the problem of analyzing and evaluating argumentative discourse. After placing argumentation in a communicative perspective, and then discussing the fallacies that occur when certain rules of communication are violated, the authors offer an alternative to both the linguistically-inspired descriptive and logically-inspired normative approaches to argumentation. The authors characterize argumentation as a complex speech act in a critical discussion aimed at resolving a difference of opinion. The various stages of a critical discussion are outlined, (...) and the communicative and interactional aspects of the speech acts performed in resolving a simple or complex dispute are discussed. After dealing with crucial aspects of analysis and linking the evaluation of argumentative discourse to the analysis, the authors identify the fallacies that can occur at various stages of discussion. Their general aim is to elucidate their own pragma- dialectical perspective on the analysis and evaluation of argumentative discourse, bringing together pragmatic insight concerning speech acts and dialectical insight concerning critical discussion. (shrink)

Walton offers a comprehensive, flexible model for physician-patient decision making, the first such tool designed to be applied at the level of each particular case. Based on Aristotelian practical reasoning, it develops a method of reasonable dialogue, a question- and-answer process of interaction leading to informed consent on the part of the patient, and to a decision--mutually arrived at--reflecting both high medical standards and the patient's felt needs. After setting forth his model, he applies it to three vital ethical issues: (...) acts of omission, the cessation of treatment, and possible side effects of treatments. In the final chapter, Walton shows how his method functions in light of the real-life complexities of the clinical encounter and how it bears on ethical questions concerning health-care policy, attitudes toward treatment and toward the medical profession, reasonableness of expectations, and the setting of realistic goals of treatment. (shrink)

The article is the first Russian translation of the most well-known piece in conversation analysis, written by the founders of CA Harvey Sacks, Emanuel Schegloff and Gail Jefferson. It has become a milestone in the development of the discipline. The authors offer a comprehensive approach to the study of conversational interactions. The approach is based on the analysis of detailed transcripts of the records of natural conversations. The authors show that in the course of the conversation co-conversationalists use a number (...) of techniques to organize the turn-taking. These techniques are combined in four rules: the first option is the transfer of speakership via allocation of the next speaker by the current speaker; if this first option is not realized, turn-taking may happen via the self-selection by one of the participants; if the second option remains unrealized too, the current speaker continues speaking, with all three options being recurrently provided at all next transition relevant places. The result of the operation of these rules is an orderly conversation based on the principle “one speaker at a time.” According to the authors, this model is compatible with obvious observations concerning conversational practices that they make. The authors show that in every conversation there is a turn-taking system in operation, which provides for a flexible adaptation of the every conversation’s structure to any possible topics and any possible speakers’ identities. Such approach considers how the participants in social interactions order their communication with each other, achieving a sense of normally occurring interaction. (shrink)