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)

This paper supports the need for health professionals to be trained in argumentation theory, by illustrating the challenges that they face in interacting with patients and according to the different models of consultation that patients prefer. While there is no ideal model of consultation that can be promoted universally, the ability to construct arguments in support of health professionals’ points of view, as well as the ability to engage in critical discussion with patients, translate in essential skills for reaching patients’ (...) agreement when communication develops through the interpretative model or the informed decision model or, eventually, shared decision-making. Keywords: models of consultation, argumentation skills, medical training, patient-centeredness, informed consent. (shrink)

The purpose of this article is to present a case for the value of argumentation as an instrument of rational persuasion in doctor-patient (and general health professional–patient) communication. By doing so, I also emphasize the value of argumentation theory—as a body of knowledge devoted to the study of argumentation—both to enrich the study of doctor-patient communication and to enhance its quality by contributing to dedicated training courses for health professionals and patient education interventions. Argumentation is used in health professional–patient interactions, (...) and its significance in this context has been acknowledged in recent literature (see the collection of articles in Rubinelli and .. (shrink)

Il passo della Retorica (1358 a 10-21) dove è introdotta la distinzione óo e i' è uno dei più controversi dell'opera aristotelica. Il presente lavoro propone un chiarimento della natura e del ruolo di óo e i' nella costruzione di un'argomentazione dialettico-retorica. Tale chiarimento viene presentato attraverso un confronto tra Topici e Retorica che, se pur espressamente evidenziato da Aristotele stesso, sembra essere stato trascurato da quanti si sono occupati dell'esegesi di tale sezione della Retorica.

In the last fifty years a series of valuable contributions on Aristotle's Topics has helped to understand how a Topics functions in the dialectical argumentation. In contrast to this, Aristotle's topoi as set out in the Rhetoric does not seem to have received the same attention. Current opinion holds that the methodology in the Rhetoric involves two different kinds of topoi, the topoi koinoi and the ídia, considered by most scholars as idioi topoi. The problem, here, is that this distinctíon (...) of is topoir is not supported by any passage in the Rhetoric. Aristotle never speaks of. This work aims to show that the term'ídia is not intended to imply'ídioi topoi. The only distinction that Aristotle introduces in the Rhetoric is that between and which also appears in the Topica and which is the consequence of a fundamental coherente in thc thcory of argumentation presented by Aristotle in the two treatises. However, the results of such investigation has revcaled that the concept of which Aristotle introduces in Rhetaric 1358 a l0 clashes with the list of topoi which appears in Rhetoric B23. In the addenda, this work addresscs this issue and make a case for the possibility that Rhetoric B23 has been originally written independently from the previous sections of the Rhetoric. (shrink)

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)

Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals. Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs’ perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs from (...) different positions and experience, including doctors and nurses in four different departments, were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient’s timing and sharing the patient’s wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs’ emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation. (shrink)

Advances in genetic research have created the need to inform consumers. Yet, the communication of hereditary risk and of the options for how to deal with it is a difficult task. Due to the abstract nature of genetics, people tend to overestimate or underestimate their risk. This paper addresses the issue of how to communicate risk information on hereditary breast and ovarian cancer through an online application. The core of the paper illustrates the design of OPERA, a risk assessment instrument (...) that applies the UK National Institute of Health and Clinical Excellence's guidelines on the basis of (i) the number of relatives on the same side of the family with the same cancer or cancers that are known to run together; (ii) the ages of these relatives at diagnosis and (iii) the closeness of the family relationship with the person who is doing the assessment. By relying on the argumentation theory, we explain how the communication strategy that OPERA implements is essentially based on Perelman and Olbrechts-Tyteca's deductive argumentation by association. By using as premises “facts” (propositions about reality that can be assumed without further justification) and “truths” (propositions that make connections about facts), OPERA delivers its claims with an ex auctoritate causal link aimed at transferring the audience's acceptance of the cause to the effect. Overall, the design of OPERA rests on its capacity to induce users' active processing of risk information through an appeal to their reasoning faculty. In the conclusion, we present some results from a pilot evaluation of users' acceptance of OPERA. (shrink)

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)