32.3582, Review: Discourse Analysis: Eemeren, Garssen, Labrie (2021)

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LINGUIST List: Vol-32-3582. Thu Nov 11 2021. ISSN: 1069 - 4875.

Subject: 32.3582, Review: Discourse Analysis: Eemeren, Garssen, Labrie (2021)

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Date: Thu, 11 Nov 2021 21:42:26
From: Pamela Sugrue [pamelasugrue at uchicago.edu]
Subject: Argumentation between Doctors and Patients

 
Discuss this message:
http://linguistlist.org/pubs/reviews/get-review.cfm?subid=36728777


Book announced at http://linguistlist.org/issues/32/32-953.html

AUTHOR: Frans H. van  Eemeren
AUTHOR: Bart  Garssen
AUTHOR: Nanon  Labrie
TITLE: Argumentation between Doctors and Patients
SUBTITLE: Understanding clinical argumentative discourse
PUBLISHER: John Benjamins
YEAR: 2021

REVIEWER: Pamela Sugrue, University of Chicago

SUMMARY

In “Argumentation Between Doctors and Patients”, Frans H. van Eemeren, Bart
Garssen, and Nanon Labrie analyze clinical interactions through the prism of
argumentation theory. The authors begin in Chapter 1 by orienting the reader
to a technical perspective on “argumentation” and include self-check exercises
at the end of each subsequent chapter, making the book suitable for students
of argumentation theory and accessible to newcomers to discourse analysis. The
theoretical background the authors apply is the “pragma-dialectal” theory of
argumentation, developed by van Eemeren and Grootendorst, which aims to be
descriptive and evaluative as it assesses an argument.

The introductory chapter begins by defining the crucial term “argument” and by
motivating the application of argumentation theory to medical discourse.
“Argumentation” here refers to a rational communicative activity aimed at
reaching a joint resolution by evaluating the merits of a statement or
statements; it does not convey combativeness. In the medical domain, an
example of an argumentative activity would be discussing a diagnosis or
treatment plan: practitioner and patient express standpoints toward a
diagnosis or treatment plan, consider the other’s statements, and accept,
question, or rebut them in an attempt to find a mutually agreed-upon stance.
The authors reason that as healthcare has progressed to encompass principles
of bodily autonomy and informed consent, argumentative discourse has become an
increasingly apt frame for studying doctor-patient interactions. In order to
successfully fulfill the obligations of legal and ethical norms that place
patients in the role of active decision-makers regarding their health, doctors
in the course of treatment must justify to patients their viewpoints and the
reasons that lead them to arrive at mutual agreement about the acceptability
of the view, and patients express their symptoms, needs, doubts, preferences,
and goals, putting forth arguments and explanations of their own in turn. The
authors further contend that using the pragma-dialectal theory behooves the
analysis of medical argumentation because it clarifies whether or not an
argument has taken place and, if so, of what sort, as well as whether the
argument was fallacious or reasonable. Ultimately the goal of such an analysis
is to allow doctors to communicate with patients regarding their health in a
maximally effective and reasonable way. Thus, the authors write, clinicians
and philosophers can apply the insights of this book productively.

In the second chapter, more background is provided on argumentation theory,
and additional analytical terms are defined. The authors first clarify that
differences of opinion need not be diametrically opposed; doubt, termed a
“non-mixed” difference of opinion, as well as opposition, also called a
“mixed” difference of opinion, suffices. It is noted that a medical evaluation
is particularly conducive to expressions of doubt, rather than opposition, on
the part of patients who may feel uncomfortable outright contradicting the
doctor. Additionally, a difference of opinion may be implicit, and it may be
anticipated -- a doctor who preemptively provides reasons supporting their
view in advance of a patient’s answer is responding to an unexpressed
difference of opinion. Arguments will be put forth to “justify” a positive
standpoint or “refute” a negative one. Although not every argumentative
discussion conforms to analytical models, the format of a model argumentative
discussion progresses through several analytical stages: a “confrontation”,
where a difference of opinion is made apparent, an opening that establishes
which baselines are mutually shared, an “argumentation”, where standpoints are
expressed and supported or refuted, and a “conclusion”, where the argument
finds resolution. The authors advise that in cases where it is not clear that
an argument is proceeding, the benefit of the doubt should be awarded such
that a “maximally argumentative interpretation” is taken, i.e., one should
assume that the participants mean to resolve the difference in their opinions.

The third chapter delves further into fundamentals of argumentation. A
“simplex” argument contains one argument backing a proposition; a “complex”
argument uses multiple arguments. There are several sub-types of complex
argumentation: “multiple”, “coordinative”, and “subordinative”. Standard
notations for representing and diagramming an argument are provided,
illustrated with examples from medical arguments. It is noted that not all
arguments are expressed, but that, where appropriate, they can be inferred
according to the communicative principle along the lines of conversational
implicature (Grice 1975).

The fourth chapter concerns the soundness of argumentation, introducing
several types of argumentation. The first is “argumentation based on a
symptomatic relation”; it is typified by the following exchange:

Y is true of X.
 > Because Z is true of X, and
 > Z is symptomatic of Y. (63)

“Argumentation based on a comparison relation” has the following logical form:

Y is appropriate for X.
 >Because Y is appropriate for Z, and
 >Z is comparable to X. (66)

“Argumentation based on a causal relation” has a separate scheme:

Y is true of X.
 >Because Z is true of X, and
 >Z leads to Y. (69)

For each argumentation type, the authors supply critical questions that can be
used to evaluate whether the argument stands: For the first: Is Z in fact
symptomatic of Y? That is, Are there Ys that do not have the characteristic Z?
Are there non-Ys that have the characteristic Z? (63) For the second: Is Z
rightly compared to X? That is, are there relevant differences between Z and
X? (67) And for the third: Does Z in fact cause Y? Could it be that something
besides Z can cause Y? Could it be that Z could happen without causing Y?
(69). The authors write that an argument’s soundness can be evaluated
according to matching it with a scheme and answering its associated critical
questions.

The fifth chapter deals with fallacious arguments, and in keeping with prior
chapters, draws its examples from medical discourse. The principle against
using fallacious arguments is that they dampen the ability of participants to
come to resolution using reasonableness as their foremost guide. The logical
fallacies are as follows: violation of the freedom rule, which has it that
participants are free to doubt or disagree with propositions expressed by one
another. Violations of the burden-of-proof rule entail a party refusing to
defend a statement to which they are committed, including, importantly, a
statement which they have implicitly committed themselves to, such as one
conversationally implicated. A violation of the standpoint rule has to do with
invoking exaggerated or invented arguments; a common example of this is
attributing fictitious arguments to one’s interlocutor: “arguing with a straw
man.” A violation of the relevance rule may involve making emotional,
point-shifting, or otherwise irrelevant arguments to the standpoint in
question in an attempt to “win” the argument by changing its scope. Another
violation may run afoul of the unexpressed premise rule: similar to the
standpoint rule, a false presentation of one’s interlocutor’s implicit premise
(or denial of one’s own implicit premise) is also a fallacious move in an
argument. The starting point rule can be violated if a party asserts that a
fact, norm, value, or assessment has been established as shared when it fact
it hasn’t been. A violation of the validity rule involves invalid reasoning,
where a logically invalid argument form is adopted. Similarly, a violation of
the argument scheme rule involves deviance from the argument schemes outlined
in Chapter 4. The closure rule is violated when the argument reaches no
conclusive resolution. The final fallacy is a violation of the usage rule; the
usage rule is violated when a party uses unclear, ambiguous, or confusing
terms in making their argument.

The sixth and final chapter concerns “strategic maneuvering” in medical
consultations, which is the necessary balance-striking between reasonableness
and effectiveness in persuasive argumentation. Strategic maneuvering can
include modifications to presentation (including presentational devices),
frame of reference invoked, and possible specific arguments made, potentially
selected for likely appeal. The authors urge caution, however, against
fallacious arguments making their way into strategic maneuvering.

EVALUATION

“Argumentation Between Doctors and Patients” 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. The main
shortcoming of the book is that, at times, the clearest connection to medicine
is in the illustrations that accompany technical definitions. That being said,
readers will find the accompanying self-check exercises and distillations of
key points helpful for digesting theory-laden ideas; teachers and professors
of argumentation will also find the accompanying exercises useful in the
classroom setting. In all, the book is a valuable resource for analyzing much
of the talk that happens in a medical exam room. For clinicians seeking to
communicate maximally effectively with patients under their care and for
researchers aiming to understand better what can go right and wrong in a
doctor-patient interaction, the authors provide a useful framework and the
analytic tools necessary to leverage it.

REFERENCES

Grice, Herbert P. ''Logic and conversation.'' “Speech acts”. Brill, 1975.
41-58.


ABOUT THE REVIEWER

Pamela Sugrue is a PhD student at the University of Chicago. She is interested
in computational linguistics.





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