Journal of Argumentation in Context - Volume 14, Issue 3, 2025

In the face of growing medical scepticism and institutional distrust, this article sketches an integrated framework to examine the interplay between public health controversies and clinical interactions. Situated within Community-Centred Approaches (CCA) and participatory public health, the framework employs tools from medical argumentation to show how doubt in healthcare interactions marks a crucial site where communicative and interpretive expertise are essential and trust is actively negotiated — a site that requires participatory practices capable of responding to and repairing it through dialogical engagement and reason-giving. Building on the concept of argumentative potential, it analyses clinical dialogue as the core community in which institutional legitimacy and interpersonal trust are negotiated. A case study on vaccine hesitancy illustrates how expressions of doubt can activate different argumentative potentials — ambivalent, sceptical, or denialist — each opening or closing discursive trajectories that either foster or erode trust. The paper advances the notion of argumentative participation as a key condition for discursive trust, illustrating how clinical dialogue can serve as a site of participatory repair, understood as the active rebuilding of trust through dialogue and shared reasoning, within broader public health controversies.

Shared decision-making has become the ideal for medical decision-making. Given the pivotal role of argumentation within this process, shared decision-making has increasingly been examined through the lens of argumentation theory, particularly pragma-dialectics. This perspective paper outlines the pragma-dialectical contributions to the analysis of shared decision-making and explores the potential of this theory for addressing current and future challenges in medical decision-making. It aims to show that normative argumentation approaches, particularly the pragma-dialectical approach, are crucial for understanding and possibly improving shared decision-making. First, the paper discusses the alignment between shared decision-making and the ideal of a critical discussion, barriers to shared decision-making as violations of discussion rules and higher-order conditions, and the application of the pragma-dialectical approach to complex decision-making scenarios involving patient companions. Second, it considers how the pragma-dialectical approach may be used to confront the emerging issues of medical misinformation and artificial intelligence in medical decision-making.

There are various ways in which Large Language Models (LLMs), the latest breakthrough in Artificial Intelligence, are relevant for medicine: this paper focuses on their potential for supporting and improving argumentation in healthcare, both for patients and for practitioners. The message is mostly positive, suggesting adoption of such systems, but with specific cautions: most notably, the need to leverage them for enhancing human communicative and epistemic performance, rather than replacing it, and the importance of training users on few key principles to guide their deployment of LLMs in healthcare. The paper is accompanied by four concrete use cases, included in the supplementary materials, that constitute an integral and crucial part of this contribution.

Health controversies are large, complex bodies of argumentative discourse. They involve committed oppositionality among people with heterogeneous interests and positions related to health, configurations of which may change over time, leaving traces in the form of argumentative texts that reflect not only pragmatic disagreements but also disagreements over epistemological questions. Understanding the complexity of health controversies requires significant investment of time and effort but also has significant disciplinary payoffs for argumentation. Because they are often sites for innovation in the practice of argumentation, health controversies hold promise for extending argumentation theory through discovery of novel phenomena. And because they are significant disagreement management challenges for society, health controversies invite the development within argumentation theory of an approach to intervention centered on valuing thorough exploration of disagreement.