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Argumentation between Doctors and Patients
Understanding clinical argumentative discourse
01
z.235
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https://benjamins.com
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A01
Frans H. van Eemeren
Eemeren, Frans H. van
Frans H.
van
Eemeren
ILIAS & Leiden University & University of Amsterdam
2
A01
Bart Garssen
Garssen, Bart
Bart
Garssen
ILIAS & University of Amsterdam
3
A01
Nanon Labrie
Labrie, Nanon
Nanon
Labrie
ILIAS & Vrije Universiteit Amsterdam
01
eng
165
x
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LAN004000
v.2006
CFG
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Communication Studies
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LIN.DISC
Discourse studies
24
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LIN.PRAG
Pragmatics
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PHIL.GEN
Philosophy
06
01
<i>Argumentation between Doctors and Patients</i> discusses the use of argumentation in clinical settings. Starting from the pragma-dialectical theory of argumentation, it aims at providing an understanding of argumentative discourse in the context of doctor-patient interaction. It explains when and how interactions between doctors and patients can be reconstructed as argumentative, what it means for doctors and patients to reasonably resolve a difference of opinion, what it implies to strive simultaneously for reasonableness and effectiveness in clinical discourse, and when such efforts derail into fallaciousness. <i>Argumentation between Doctors and Patients</i> is of interest to all those who seek to improve their understanding of argumentation in a medical context – whether they are students, scholars of argumentation, or medical practitioners.<br />Frans H. van Eemeren, Bart Garssen and Nanon Labrie are prominent argumentation theorists. In writing <i>Argumentation between Doctors and Patients</i>, they have benefited from the advice of an Advisory Board consisting of both medical practitioners and argumentation scholars.
05
From our point of view, <i>Argumentation between Doctors and Patients: Understanding </i><i>Clinical Argumentative Discourse</i> is a truly thought-provoking book, with immense academic value for the understanding of argumentation in the field of clinical discourse. No doubt, this book will spark the interest of researchers in the fields of discourse analysis, pragmatics and rhetoric
Lei Zhu, Shanghai University of Political Science and Law & Wei Wang, Shanghai Jianqiao University, in Argumentation 37 (2023).
05
<i>Argumentation between Doctors and Patients</i> comes at a timely moment in the Covid-19 pandemic. As a resource for increasing clarity in doctor-patient communication, the book fulfills a useful role especially pertinent to the moment. It is remarkably accessible to newcomers to argumentation theory, and correspondingly a heavy emphasis is placed on introducing fundamentals. The connection between theory of argument and the medical field comes out mainly in the examples of technical terms supplied within the chapters
Pamela Sugrue, University of Chicago, on Linguist List 32.3582 (11 November 2021)
05
It is a useful read for anyone interested in (clinical) argumentative discourse.
Eniola Boluwaduro, Redeemer’s University & Westfälische Wilhelms-Universität Münster, in Journal of Pragmatics 191 (2022)
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Verbal interaction between doctors and patients is inherent to the medical profession. When the communicative interaction between doctors and patients is aimed at exchanging different viewpoints through discussion in order to reach a (treatment) decision, it can be said that the dialogue that emerges is argumentative in nature. It is important to note here that the term ‘argumentation’ bears no negative connotation. Rather it refers to a resolution-oriented process that is aimed at justifying or refuting a standpoint – an opinion, judgment, preference, or recommendation at issue in the discourse. Medical consultation can be referred to as an argumentative activity type. This means that the argumentative discourse between doctors and patients is influenced by the rules, standards, and conventions that apply to medical consultation. Argumentative processes between doctors and patients can be understood through careful study of their discourse. In doing so, a theoretical approach is required that makes clear how the argumentative discourse concerned is to be analyzed and evaluated. The pragma-dialectical theory of argumentation, which forms the theoretical framework of this volume, can be used to describe the use of argumentation in clinical settings as well as to evaluate the uses of argumentation in doctor-patient communication. This is particularly useful for anyone who seeks to both understand and improve the use of argumentation in practice.
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Argumentative discussions are part of everyday clinical discourse. Doctors and patients may explicitly or implicitly have different opinions about various issues, such as the causes of patients’ symptoms or the best course of action. Through argumentative discussions, these differences can be resolved. Medical standpoints, which can be advanced by both doctors and patients, may concern a myriad of topics and different types of standpoints can be distinguished (factual and predictive claims; judgments; recommendations). When a standpoint is advanced, it may meet with doubt (unmixed difference of opinion) or opposition (mixed difference of opinion). Verbal indicators in the text, as well as clues from the situational context, can be used to identify standpoints as well as their supporting arguments. Analytically, an argumentative discussion consists of four consecutive stages: confrontation, opening, argumentation, and conclusion. Knowing about these stages is helpful when striving to understand, analyze, and evaluate argumentation in clinical settings.
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Chapter 3. The argumentation structure
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Argumentation advanced by a doctor or a patient in medical consultations consists in the simplest case of just one single argument, but can also have a more complex structure. If the argumentation consists of more than one alternative defense of the same standpoint, the argumentation structure is called <i>multiple</i>. If the argumentation consists of several arguments that need to be taken together, the argumentation structure is <i>coordinative</i>. Another type of complex argumentation occurs when one argument supports the other. In this case the argumentation structure is called subordinative. Sometimes a doctor or patient makes clear in the presentation of the argumentation what the argumentation structure is by the use of verbal indicators of multiple, coordinative, or subordinative argumentation, but more often than not in the argumentative exchange taking place in a medical consultation no such indicators are to be found. When in doubt about whether the argumentation advanced by the doctor or the patient is multiple or coordinative, one is advised to opt for a “maximally argumentative analysis” and regard the argumentation as multiple, so that every component of the doctor’s or the patient’s argumentation will be maximally given its due when the defense of the standpoint is evaluated. In a well-defined context, such as a medical consultation, the reconstruction of elements that have been left unexpressed in the discourse can sometimes be helpful in providing a more adequate analysis of subordinative argumentation.
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In advancing argumentation to convince patients of the acceptability of their standpoint, doctors must anticipate critical reactions from the patients that are to be convinced – and patients must do the same with regard to the critical reactions of doctors. In order to make sure that the argumentation advanced by the doctor or the patient is to be considered sound, every individual argument that is part of the argumentation needs to be assessed for its acceptability. In carrying out this assessment, one must determine for each single argumentation whether the propositions expressed in it are acceptable, whether the reasoning involved is valid or can be reconstructed as valid, and whether the critical questions relevant to the type of argumentation used by the doctor or the patient can be answered satisfactorily. In carrying out the last part of the assessment, three main types of argumentation are to be distinguished: argumentation based on a symptomatic relation between the reason put forward in the argumentation and the standpoint, argumentation based on a comparison relation, and argumentation based on a causal relation.
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In argumentative discussions fallacies need to be avoided. Fallacies are violations of the rules for critical discussion introduced in this Chapter, which prevent or hinder a difference of opinion to be resolved based on the merits of the argumentation that is advanced. Fallacies can occur in all stages of the discussion and can be committed by either party. Among the fallacies that may occur in the presentation of standpoints and arguments are putting under pressure and expressing inappropriate personal criticism (Freedom Rule, 1), evading or shifting the burden of proof (Burden-of-Proof Rule, 2), misrepresenting the other party’s standpoint (Standpoint Rule, 3), using irrelevant argumentation or non-argumentation (Relevance Rule, 4), and denying or magnifying an unexpressed premise (Unexpressed Premise Rule, 5). Among the fallacies that may occur in judging the argumentation are falsely treating a starting point as agreed upon or denying a starting point that had been agreed upon (Starting Point Rule, 6), using invalid reasoning (Validity Rule, 7), and employing an inappropriate argument scheme or using an argument scheme incorrectly (Argument Scheme Rule, 8). In drawing conclusions, unwarranted consequences may be attached to a successful defense or a failed defense (Closure Rule, 9). Finally, the resolution of a difference can be obstructed in any stage by inconsistent, unclear or ambiguous use of language (Usage Rule, 10).
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When doctors and patients argue their case, they are always confronted with the “argumentative predicament” that all argumentative moves they make need to be reasonable and effective at the same time. To reconcile the simultaneous pursuit of maintaining reasonableness and aiming for effectiveness, in medical consultations strategic maneuvering is required. Strategic maneuvering has three aspects, which affect each other mutually: selection from the topical potential of argumentative moves, adaptation to audience demand, and exploitation of presentational devices. In a medical consultation, strategic maneuvering takes place in all stages of the argumentative process and each argumentative move has both a reasonableness dimension and an effectiveness dimension. A series of argumentative moves is said to combine into a fully-fledged argumentative strategy when the three aspects of strategic maneuvering are coordinated within each argumenatiave move, as well as across all consecutive argumentative moves that are part of the series. When the doctor’s or the patient’s strategic maneuvering derails, this results in fallacies, which may easily go unnoticed by the other party because fallacious argumentative moves have a similar appearance as sound argumentative moves.
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Terminology
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Index
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JBENJAMINS
John Benjamins Publishing Company
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John Benjamins Publishing Company
Amsterdam/Philadelphia
NL
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20210211
2021
John Benjamins B.V.
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Argumentation between Doctors and Patients
Understanding clinical argumentative discourse
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Frans H. van Eemeren
Eemeren, Frans H. van
Frans H.
van
Eemeren
ILIAS & Leiden University & University of Amsterdam
2
A01
Bart Garssen
Garssen, Bart
Bart
Garssen
ILIAS & University of Amsterdam
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Nanon Labrie
Labrie, Nanon
Nanon
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ILIAS & Vrije Universiteit Amsterdam
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<i>Argumentation between Doctors and Patients</i> discusses the use of argumentation in clinical settings. Starting from the pragma-dialectical theory of argumentation, it aims at providing an understanding of argumentative discourse in the context of doctor-patient interaction. It explains when and how interactions between doctors and patients can be reconstructed as argumentative, what it means for doctors and patients to reasonably resolve a difference of opinion, what it implies to strive simultaneously for reasonableness and effectiveness in clinical discourse, and when such efforts derail into fallaciousness. <i>Argumentation between Doctors and Patients</i> is of interest to all those who seek to improve their understanding of argumentation in a medical context – whether they are students, scholars of argumentation, or medical practitioners.<br />Frans H. van Eemeren, Bart Garssen and Nanon Labrie are prominent argumentation theorists. In writing <i>Argumentation between Doctors and Patients</i>, they have benefited from the advice of an Advisory Board consisting of both medical practitioners and argumentation scholars.
05
From our point of view, <i>Argumentation between Doctors and Patients: Understanding </i><i>Clinical Argumentative Discourse</i> is a truly thought-provoking book, with immense academic value for the understanding of argumentation in the field of clinical discourse. No doubt, this book will spark the interest of researchers in the fields of discourse analysis, pragmatics and rhetoric
Lei Zhu, Shanghai University of Political Science and Law & Wei Wang, Shanghai Jianqiao University, in Argumentation 37 (2023).
05
<i>Argumentation between Doctors and Patients</i> comes at a timely moment in the Covid-19 pandemic. As a resource for increasing clarity in doctor-patient communication, the book fulfills a useful role especially pertinent to the moment. It is remarkably accessible to newcomers to argumentation theory, and correspondingly a heavy emphasis is placed on introducing fundamentals. The connection between theory of argument and the medical field comes out mainly in the examples of technical terms supplied within the chapters
Pamela Sugrue, University of Chicago, on Linguist List 32.3582 (11 November 2021)
05
It is a useful read for anyone interested in (clinical) argumentative discourse.
Eniola Boluwaduro, Redeemer’s University & Westfälische Wilhelms-Universität Münster, in Journal of Pragmatics 191 (2022)
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Verbal interaction between doctors and patients is inherent to the medical profession. When the communicative interaction between doctors and patients is aimed at exchanging different viewpoints through discussion in order to reach a (treatment) decision, it can be said that the dialogue that emerges is argumentative in nature. It is important to note here that the term ‘argumentation’ bears no negative connotation. Rather it refers to a resolution-oriented process that is aimed at justifying or refuting a standpoint – an opinion, judgment, preference, or recommendation at issue in the discourse. Medical consultation can be referred to as an argumentative activity type. This means that the argumentative discourse between doctors and patients is influenced by the rules, standards, and conventions that apply to medical consultation. Argumentative processes between doctors and patients can be understood through careful study of their discourse. In doing so, a theoretical approach is required that makes clear how the argumentative discourse concerned is to be analyzed and evaluated. The pragma-dialectical theory of argumentation, which forms the theoretical framework of this volume, can be used to describe the use of argumentation in clinical settings as well as to evaluate the uses of argumentation in doctor-patient communication. This is particularly useful for anyone who seeks to both understand and improve the use of argumentation in practice.
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Argumentative discussions are part of everyday clinical discourse. Doctors and patients may explicitly or implicitly have different opinions about various issues, such as the causes of patients’ symptoms or the best course of action. Through argumentative discussions, these differences can be resolved. Medical standpoints, which can be advanced by both doctors and patients, may concern a myriad of topics and different types of standpoints can be distinguished (factual and predictive claims; judgments; recommendations). When a standpoint is advanced, it may meet with doubt (unmixed difference of opinion) or opposition (mixed difference of opinion). Verbal indicators in the text, as well as clues from the situational context, can be used to identify standpoints as well as their supporting arguments. Analytically, an argumentative discussion consists of four consecutive stages: confrontation, opening, argumentation, and conclusion. Knowing about these stages is helpful when striving to understand, analyze, and evaluate argumentation in clinical settings.
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Chapter 3. The argumentation structure
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Argumentation advanced by a doctor or a patient in medical consultations consists in the simplest case of just one single argument, but can also have a more complex structure. If the argumentation consists of more than one alternative defense of the same standpoint, the argumentation structure is called <i>multiple</i>. If the argumentation consists of several arguments that need to be taken together, the argumentation structure is <i>coordinative</i>. Another type of complex argumentation occurs when one argument supports the other. In this case the argumentation structure is called subordinative. Sometimes a doctor or patient makes clear in the presentation of the argumentation what the argumentation structure is by the use of verbal indicators of multiple, coordinative, or subordinative argumentation, but more often than not in the argumentative exchange taking place in a medical consultation no such indicators are to be found. When in doubt about whether the argumentation advanced by the doctor or the patient is multiple or coordinative, one is advised to opt for a “maximally argumentative analysis” and regard the argumentation as multiple, so that every component of the doctor’s or the patient’s argumentation will be maximally given its due when the defense of the standpoint is evaluated. In a well-defined context, such as a medical consultation, the reconstruction of elements that have been left unexpressed in the discourse can sometimes be helpful in providing a more adequate analysis of subordinative argumentation.
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In advancing argumentation to convince patients of the acceptability of their standpoint, doctors must anticipate critical reactions from the patients that are to be convinced – and patients must do the same with regard to the critical reactions of doctors. In order to make sure that the argumentation advanced by the doctor or the patient is to be considered sound, every individual argument that is part of the argumentation needs to be assessed for its acceptability. In carrying out this assessment, one must determine for each single argumentation whether the propositions expressed in it are acceptable, whether the reasoning involved is valid or can be reconstructed as valid, and whether the critical questions relevant to the type of argumentation used by the doctor or the patient can be answered satisfactorily. In carrying out the last part of the assessment, three main types of argumentation are to be distinguished: argumentation based on a symptomatic relation between the reason put forward in the argumentation and the standpoint, argumentation based on a comparison relation, and argumentation based on a causal relation.
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Chapter 6. Strategic maneuvering in medical consultations
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Terminology
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Members Advisory Board
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References
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153
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Index
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JBENJAMINS
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Amsterdam/Philadelphia
NL
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20210211
2021
John Benjamins B.V.
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Argumentation between Doctors and Patients
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01
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https://benjamins.com/catalog/z.235
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A01
Frans H. van Eemeren
Eemeren, Frans H. van
Frans H.
van
Eemeren
ILIAS & Leiden University & University of Amsterdam
2
A01
Bart Garssen
Garssen, Bart
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ILIAS & University of Amsterdam
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ILIAS & Vrije Universiteit Amsterdam
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LAN004000
v.2006
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PHIL.GEN
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01
<i>Argumentation between Doctors and Patients</i> discusses the use of argumentation in clinical settings. Starting from the pragma-dialectical theory of argumentation, it aims at providing an understanding of argumentative discourse in the context of doctor-patient interaction. It explains when and how interactions between doctors and patients can be reconstructed as argumentative, what it means for doctors and patients to reasonably resolve a difference of opinion, what it implies to strive simultaneously for reasonableness and effectiveness in clinical discourse, and when such efforts derail into fallaciousness. <i>Argumentation between Doctors and Patients</i> is of interest to all those who seek to improve their understanding of argumentation in a medical context – whether they are students, scholars of argumentation, or medical practitioners.<br />Frans H. van Eemeren, Bart Garssen and Nanon Labrie are prominent argumentation theorists. In writing <i>Argumentation between Doctors and Patients</i>, they have benefited from the advice of an Advisory Board consisting of both medical practitioners and argumentation scholars.
05
From our point of view, <i>Argumentation between Doctors and Patients: Understanding </i><i>Clinical Argumentative Discourse</i> is a truly thought-provoking book, with immense academic value for the understanding of argumentation in the field of clinical discourse. No doubt, this book will spark the interest of researchers in the fields of discourse analysis, pragmatics and rhetoric
Lei Zhu, Shanghai University of Political Science and Law & Wei Wang, Shanghai Jianqiao University, in Argumentation 37 (2023).
05
<i>Argumentation between Doctors and Patients</i> comes at a timely moment in the Covid-19 pandemic. As a resource for increasing clarity in doctor-patient communication, the book fulfills a useful role especially pertinent to the moment. It is remarkably accessible to newcomers to argumentation theory, and correspondingly a heavy emphasis is placed on introducing fundamentals. The connection between theory of argument and the medical field comes out mainly in the examples of technical terms supplied within the chapters
Pamela Sugrue, University of Chicago, on Linguist List 32.3582 (11 November 2021)
05
It is a useful read for anyone interested in (clinical) argumentative discourse.
Eniola Boluwaduro, Redeemer’s University & Westfälische Wilhelms-Universität Münster, in Journal of Pragmatics 191 (2022)
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Preface
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Chapter 1. Argumentation between doctors and patients
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Verbal interaction between doctors and patients is inherent to the medical profession. When the communicative interaction between doctors and patients is aimed at exchanging different viewpoints through discussion in order to reach a (treatment) decision, it can be said that the dialogue that emerges is argumentative in nature. It is important to note here that the term ‘argumentation’ bears no negative connotation. Rather it refers to a resolution-oriented process that is aimed at justifying or refuting a standpoint – an opinion, judgment, preference, or recommendation at issue in the discourse. Medical consultation can be referred to as an argumentative activity type. This means that the argumentative discourse between doctors and patients is influenced by the rules, standards, and conventions that apply to medical consultation. Argumentative processes between doctors and patients can be understood through careful study of their discourse. In doing so, a theoretical approach is required that makes clear how the argumentative discourse concerned is to be analyzed and evaluated. The pragma-dialectical theory of argumentation, which forms the theoretical framework of this volume, can be used to describe the use of argumentation in clinical settings as well as to evaluate the uses of argumentation in doctor-patient communication. This is particularly useful for anyone who seeks to both understand and improve the use of argumentation in practice.
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Chapter 2. Argumentation and resolving differences of opinion
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Argumentative discussions are part of everyday clinical discourse. Doctors and patients may explicitly or implicitly have different opinions about various issues, such as the causes of patients’ symptoms or the best course of action. Through argumentative discussions, these differences can be resolved. Medical standpoints, which can be advanced by both doctors and patients, may concern a myriad of topics and different types of standpoints can be distinguished (factual and predictive claims; judgments; recommendations). When a standpoint is advanced, it may meet with doubt (unmixed difference of opinion) or opposition (mixed difference of opinion). Verbal indicators in the text, as well as clues from the situational context, can be used to identify standpoints as well as their supporting arguments. Analytically, an argumentative discussion consists of four consecutive stages: confrontation, opening, argumentation, and conclusion. Knowing about these stages is helpful when striving to understand, analyze, and evaluate argumentation in clinical settings.
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Chapter 3. The argumentation structure
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Argumentation advanced by a doctor or a patient in medical consultations consists in the simplest case of just one single argument, but can also have a more complex structure. If the argumentation consists of more than one alternative defense of the same standpoint, the argumentation structure is called <i>multiple</i>. If the argumentation consists of several arguments that need to be taken together, the argumentation structure is <i>coordinative</i>. Another type of complex argumentation occurs when one argument supports the other. In this case the argumentation structure is called subordinative. Sometimes a doctor or patient makes clear in the presentation of the argumentation what the argumentation structure is by the use of verbal indicators of multiple, coordinative, or subordinative argumentation, but more often than not in the argumentative exchange taking place in a medical consultation no such indicators are to be found. When in doubt about whether the argumentation advanced by the doctor or the patient is multiple or coordinative, one is advised to opt for a “maximally argumentative analysis” and regard the argumentation as multiple, so that every component of the doctor’s or the patient’s argumentation will be maximally given its due when the defense of the standpoint is evaluated. In a well-defined context, such as a medical consultation, the reconstruction of elements that have been left unexpressed in the discourse can sometimes be helpful in providing a more adequate analysis of subordinative argumentation.
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Chapter 4. Assessing the soundness of argumentation
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In advancing argumentation to convince patients of the acceptability of their standpoint, doctors must anticipate critical reactions from the patients that are to be convinced – and patients must do the same with regard to the critical reactions of doctors. In order to make sure that the argumentation advanced by the doctor or the patient is to be considered sound, every individual argument that is part of the argumentation needs to be assessed for its acceptability. In carrying out this assessment, one must determine for each single argumentation whether the propositions expressed in it are acceptable, whether the reasoning involved is valid or can be reconstructed as valid, and whether the critical questions relevant to the type of argumentation used by the doctor or the patient can be answered satisfactorily. In carrying out the last part of the assessment, three main types of argumentation are to be distinguished: argumentation based on a symptomatic relation between the reason put forward in the argumentation and the standpoint, argumentation based on a comparison relation, and argumentation based on a causal relation.
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Chapter 5. Fallacies in medical consultations
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In argumentative discussions fallacies need to be avoided. Fallacies are violations of the rules for critical discussion introduced in this Chapter, which prevent or hinder a difference of opinion to be resolved based on the merits of the argumentation that is advanced. Fallacies can occur in all stages of the discussion and can be committed by either party. Among the fallacies that may occur in the presentation of standpoints and arguments are putting under pressure and expressing inappropriate personal criticism (Freedom Rule, 1), evading or shifting the burden of proof (Burden-of-Proof Rule, 2), misrepresenting the other party’s standpoint (Standpoint Rule, 3), using irrelevant argumentation or non-argumentation (Relevance Rule, 4), and denying or magnifying an unexpressed premise (Unexpressed Premise Rule, 5). Among the fallacies that may occur in judging the argumentation are falsely treating a starting point as agreed upon or denying a starting point that had been agreed upon (Starting Point Rule, 6), using invalid reasoning (Validity Rule, 7), and employing an inappropriate argument scheme or using an argument scheme incorrectly (Argument Scheme Rule, 8). In drawing conclusions, unwarranted consequences may be attached to a successful defense or a failed defense (Closure Rule, 9). Finally, the resolution of a difference can be obstructed in any stage by inconsistent, unclear or ambiguous use of language (Usage Rule, 10).
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Chapter 6. Strategic maneuvering in medical consultations
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When doctors and patients argue their case, they are always confronted with the “argumentative predicament” that all argumentative moves they make need to be reasonable and effective at the same time. To reconcile the simultaneous pursuit of maintaining reasonableness and aiming for effectiveness, in medical consultations strategic maneuvering is required. Strategic maneuvering has three aspects, which affect each other mutually: selection from the topical potential of argumentative moves, adaptation to audience demand, and exploitation of presentational devices. In a medical consultation, strategic maneuvering takes place in all stages of the argumentative process and each argumentative move has both a reasonableness dimension and an effectiveness dimension. A series of argumentative moves is said to combine into a fully-fledged argumentative strategy when the three aspects of strategic maneuvering are coordinated within each argumenatiave move, as well as across all consecutive argumentative moves that are part of the series. When the doctor’s or the patient’s strategic maneuvering derails, this results in fallacies, which may easily go unnoticed by the other party because fallacious argumentative moves have a similar appearance as sound argumentative moves.
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Epilogue
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Terminology
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Members Advisory Board
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About the authors
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References
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Miscellaneous
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Index
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