Journal of Argumentation in Context - Volume 7, Issue 2, 2018

Recent research on medical communication discusses the role of argumentation in building physician-patient consensus to enhance shared decision-making. This paper focuses on the potential of using argumentation to establish the preliminary step of shared understanding of the diagnosis. This understanding is important in helping patients accept the disease and in increasing their involvement in care. We conducted an in-depth analysis of an observation of a medical encounter, triangulated with interviews with all participants, to illustrate how the lack of clear information and argumentation concerning the disease hindered the patient’s understanding and acceptance of it. This in turn led to difficulties in building a trusting relationship and in reaching treatment decisions. We discuss how using argumentation focused on the disease can allow a fruitful patient-centered discussion about the medical condition and treatment options.

In this paper, argumentation practices will be discussed in view of their potential for favoring effective information sharing and the creation of ‘emergent common ground’, i.e. the common ground that is sought, created and co-constructed in the process of communication. Argumentation is usually tightly knit with information sharing: if the parties have not previously shared a sufficient amount of relevant knowledge, it is difficult for them to produce effective argumentation. Based on these premises, in this paper the argumentation stages of medical encounters will be viewed as opportunities to reveal and integrate insufficient common ground between clinicians and patients. By relying on the analysis of a corpus of real life encounters in a chronic care setting, the interaction between information sharing and argumentation will be shown, along with problematic cases of misunderstandings or ineffective argumentation due to lack of common ground. Implications for the clinical practice will be discussed.

Shared medical decision-making has been analyzed as a particular kind of argumentative discussion. In the pragma-dialectical argumentation theory, different types of conditions and rules are formulated for the ideal of a reasonable argumentative discussion. In this paper, we shall first show how making use of the distinctions made in the pragma-dialectical theory between different types of conditions for reasonable discussion can help to give a more systematic account of the obstacles that need to be overcome for shared decision-making to be successful. Next, by referring to the rules for critical discussion, we shall provide a more detailed explanation than can be found in the literature on health communication of why certain types of conduct of the participants in the medical encounter can be analyzed as obstacles to the goal of shared decision-making.

A recent line of argumentation research has focused on the examination of prototypical argumentative patterns – patterns that can be theoretically expected in view of the type of standpoint defended, the institutional aim, and the conventions and constraints of the context (Van Eemeren 2016: 13–15). This paper aims to add a new dimension to both this line of research and research on health communication by determining whether the prototypical types of argumentation in consultations about palliative systemic treatment for advanced cancer are stereotypical as well, that is, whether they are dominant in a quantitative sense (van Eemeren 2016: 16). For this purpose, a valid and reliable measurement instrument is developed and used in a content analysis of the transcripts of 49 consultations. On the basis of the results of this analysis, it can be concluded that the use of symptomatic and pragmatic argumentation is stereotypical in this type of consultations.

If the arguments to support a recommendation are partly implicit, the free exchange of ideas between discussants can be hampered. In this paper, we will focus on the potential pitfall for clinicians when informing patients about treatment options: implicit persuasion. We will describe a set of implicitly persuasive behaviors observed during decision-making consultations, and reflect on how these behaviors could undermine efforts to stimulate patient participation in decision-making. We will also reflect on possible explanations for why clinicians exhibit such behaviors.

This article explores ethical aspects of using open argumentation in person-centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences, or value commitments of patients. We argue that such disputing may be claimed to have an important place in advanced versions of PCC, but that it actualizes important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry, and public health interventions, such as antibiotic stewardship programs, as examples. These contexts offer new reasons for why PCC may or should include open disputing with patients, but also introduce new ethical complications. Some of these may transform either to arguments against PCC implementation in these areas, or to a more open view of the extent a HP may seek to dominate patients in a PCC setting. We are especially skeptical of the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of compulsory elements, such as forensic psychiatric detention.