1527 Chapter 137 A Doctor’s Argumentation by Authority as a Strategic Manoeuvre Roosmaryn Pilgram University of Amsterdam 1. Introduction Argumentation can play an important role in medical consultation. Central to medical consultation is a patient’s health related problem and a doctor’s medical advice, diagnosis and/or prognosis concerning this problem. Especially when such advice, diagnosis and/or prognosis can be expected to have a big impact on the patient, a doctor might assume the patient to be hesitant to immediately accept his claim(s). The doctor could attempt to overcome such hesitance by presenting argumentation. For instance, a doctor who advises a patient to drastically change his diet might attempt to make such advice acceptable by arguing “Your cholesterol level is too high”. The context of a medical consultation does not just enable the doctor to present argumentation; it also affects the way in which the doctor provides this argumentation. Medical consultation is a regulated institutionalised communicative practice that is conducted in a limited amount of time. The health related problem that is central to such a consultation might be of vital importance to the patient, making the discussion of this problem potentially emotion laden. Furthermore, the doctor and patient differ in the amount of knowledge and experience they possess about the patient’s health related problem. As a result of these characteristics, the argumentation by a doctor in medical consultation typically differs significantly from that in, say, informal argumentative exchanges. Because of a medical consultation’s limited amount of time and the fact that the doctor can be considered an authority on the patient’s health related problem, a doctor might decide to present argumentation by authority in support his claim(s). After all, the patient has acknowledged the doctor’s authority on medical knowledge by requesting a medical consultation, so it could be effective for a doctor to refer to this authority in support of his medical claim(s). On the other hand, a doctor’s argumentation by authority could essentially exclude the patient from the decision making process about the patient’s health related problem. This would limit the patient’s autonomy, reflecting a paternalistic form of the doctor-patient relationship that goes against the idea that medical consultation should be based on shared decision-making by the doctor and patient (see, on paternalism, Roter & Hall 2006; and, on shared decision making, Légaré et al, 2008; Frosch & Kaplan 1999). To what extent can a doctor’s argumentation by authority then be regarded as reasonable? To determine the extent to which a doctor’s argumentation by authority in medical consultation can be regarded as reasonable, it is necessary to first provide a detailed account of a doctor’s rationale for presenting this kind of argumentation. Based on the extended pragma-dialectical theory, I shall provide such an account by analysing a doctor’s argumentation by authority as a strategic manoeuvre. Concretely, I shall, first, discuss the extended pragma-dialectical theory. Second, I shall provide a description of what I regard as argumentation by authority. Third, I shall examine a