, Volume 20, Issue 3, pp 353–375 | Cite as

“Let Me Tell You Why!”. When Argumentation in Doctor–Patient Interaction Makes a Difference

  • Sara RubinelliEmail author
  • Peter J. Schulz


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.


doctor–patient relationship pragma-dialectic theory of argumentation ancient rhetoric informed consent decision-making 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Applebaum P. S., Lidz C. W., Meisel A.: 1987, Informed Consent: Legal Theory and Clinical Practice New York, NY, Oxford University PressGoogle Scholar
  2. Bachers, D. E., S. M. Haas and L. J. Neidig: 2002, ‚Satisfying the Argumentative Requirements for Self-advocacy’, in Van Eemeren, op. cit., pp. 291–308Google Scholar
  3. Ballard-Reisch D. S.: 1990, A Model of Participative Decision Making for Physician–Patient Interaction Health Communication 2: 91–104CrossRefGoogle Scholar
  4. Beauchamp T. L.: 1994, Childress JF. Principles of Biomedical Ethics 4th ed, New York, Oxford University PressGoogle Scholar
  5. Bredart A., Bouleuc C., Dolbeault S.: 2005 Doctor–Patient Communication and Satisfaction with Care in Oncology Current Opinion in Oncology 17(4): 351–4CrossRefGoogle Scholar
  6. Caffi C.: 2002, La Mitigazione. Un approccio pragmatico alla comunicazione nei contesti terapeutici. Münster: Lit VerlagGoogle Scholar
  7. Charles C., Whelan T., Gafni A.: 2004, What Do We Mean by Partnership in Making Decisions About Treatment? British Medical Journal 319(7212): 780–782Google Scholar
  8. Chin J. J.: 2002, Doctor–Patient Relationship: From Medical Paternalism to Enhanced Autonomy Singapore Medical Journal 43(3): 152–155Google Scholar
  9. Davis D. D.: 1997, Phronesis, Clinical Reasoning, and Pellegrino’s Philosophy of Medicine Theoretical Medicine 18(1–2): 173–195CrossRefGoogle Scholar
  10. Dickinson H. D.: 1998, Evidence-based Decision-making: An Argumentative Approach International Journal of Medical Informatics 51(2–3): 71–81CrossRefGoogle Scholar
  11. Doyal L. T. (ed.) : 2000, Informed Consent in Medical Research London, BMJ PublicationsGoogle Scholar
  12. Eddy D. M.: 1990, Clinical Decision Making: From Theory to Practice. Anatomy of Decision The Journal of the American Medical Association 263(3): 441–443CrossRefGoogle Scholar
  13. Evidence-based Medicine Working Group: 1994, Evidence-based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of Dental Education 58(8): 648–653Google Scholar
  14. Faden R., Beauchamp T.: 1986, A History and Theory of Informed Consent New York: Oxford University PressGoogle Scholar
  15. Frederikson L. G.: 1993, Development of an Integrative Model for Medical Consultation Health Communication 5: 225–237CrossRefGoogle Scholar
  16. Grasso A., Cawsey A., Jones R.: 2000, Dialectical Argumentation to Solve Conflicts in Advice Giving: A Case Study in the Promotion of Healthy Nutrition International Journal of Human-Computer Studies 53(6): 1077–1115CrossRefGoogle Scholar
  17. Henkemans, F. S.: 2001, ‚Argumentation, Explanation and Causality: An Exploration of Current Linguistic Approaches to Textual Relations’, in T. Sanders and W. Spooren (eds.), Text Representation. Linguistic and Psycholinguistic Aspects, pp. 231–247, John Benjamins Publishing CompanyGoogle Scholar
  18. Laine C., Davidoff F.: 1996, Patient-centered Medicine. A Professional Evolution The Journal of the American Medical Association 275(2): 152–156CrossRefGoogle Scholar
  19. Lowe M., Kerridge I.: 1997, Informed Consent and Shared Decision Making Student British Medical Journal 5: 275–277Google Scholar
  20. Maguire P., Pitceathly C.: 2002, Key Communication Skills and How to Acquire Them British Medical Journal 325(7366): 697–700CrossRefGoogle Scholar
  21. Pellegrino E. D.: 1979, Toward a Reconstruction of Medical Morality: The Primacy of the Act of Profession and the Fact of Illness Journal of Medicine and Philosophy 4(1): 32–56Google Scholar
  22. Pellegrino E. D., Thomasma D. C.: 1981, A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of Healing Professions New York, Oxford University PressGoogle Scholar
  23. Perelman, C. and L. Olbrechts-Tyteca: 1958, Traité de l’Argumentation. La Nouvelle Rhétorique, Presses Universitaires de FranceGoogle Scholar
  24. Quill T. E., Brody H.: 1996, Physician Recommendations and Patient. Autonomy Finding a Balance Between Physician Power and Patient Choice Annals of Internal Medicine 125(9): 736–769Google Scholar
  25. Rigotti, E. and S. Greco: 2005: ‚Argomentazione nelle istituzioni’ ARGUMENTUM eLearning module, www.argumentum.chGoogle Scholar
  26. Sascks H., Schegloff E., Jefferson G.: 1974, A Simplex Systematic for the Organization of Turn-Taking for Conversation Language 50(4): 696–735CrossRefGoogle Scholar
  27. Schulz, P.J.: 2003, ‚Effetti mediatici sull’interazione medico-paziente’, in S. Rubinelli and B. Crivelli (eds.), Televisione, stampa e internet tra medico e paziente, Tribuna Medica, 7–10 (Special Issue)Google Scholar
  28. Schulz, P.J.: 2006, ‚The Communication of Diagnostic Information by Doctors to Patients in the Consultation’, in P. Twohig and V. Kalitzkus (eds.), Bordering Biomedicine, pp. 103–118Google Scholar
  29. Schulz, P.J. and S. Rubinelli: 2006, ‚Healthy Arguments for Literacy in Health’, Proceedings of the American Association for Artificial Intelligence (AAAI). Spring Symposium on Argumentation for Consumers of Healthcare, Palo Alto, CA, March 2006, pp. 86–95Google Scholar
  30. Tan NHSS: 2002, Deconstructing Paternalism – What Serves the Patient Best? Singapore Medical Journal 43(3): 148–151Google Scholar
  31. Upshur R.E.G., Colak E.: 2003, Argumentation and Evidence Theoretical Medicine and Bioethics 24(4):283–299CrossRefGoogle Scholar
  32. Van Eemeren F., Grootendorst R.: 1992, Argumentation, Communication, and Fallacies. A Pragma-Dialectical Perspective Lawrence Erlbaum Associates Publishers, Hillsdale and LondonGoogle Scholar
  33. Van Eemeren F., Grootendorst R., Henkemans F. S.: 2002, Argumentation. Analysis, Evaluation, Presentation Lawrence Erlbaum Associates Publishers, Mahwah and LondonGoogle Scholar
  34. Van Eemerenm F., Grotendorst R.: 2004, A Systematic Theory of Argumentation The pragma-dialectical approach, CambridgeGoogle Scholar
  35. Walton D. N.: 1985, Physician–Patient Decision-making. A Study in Medical Ethics Greenwood Press, Connecticut and LondonGoogle Scholar
  36. Wear S.: 1998, Informed Consent: Patient Autonomy and Clinician Beneficence Within Health Care Washington, DC, Georgetown University PressGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Health Care Communication Laboratory, School of Communication SciencesUniversity of LuganoLuganoSwitzerland

Personalised recommendations