What is Toulmin Argument
- Backing Statements
These are the evidence that you will use to support your claim or position.
The statement which you are offering for others, such as your readers or listeners, to accept.
These link your data/grounds with your claim. They also explain why the data supports the claim.
These are words or phrases which show the strength of the connection between the claim and the data.
These are the arguments which are directed against the possible objections to your claim.
These give extra support to your warrants.
Here is an example of a Toulmin Argument:
You should stop smoking [Claim]because studies show that almost [Qualifier] 80% of smokers can develop lung cancer [Data/Ground]. Stopping a bad habit can help reduce the occurence of its bad consequences[Warrant, *can be stated or left unstated]. Life expectancy is lengthened if habits bad to one's health are stopped [Backing Statement]. Although it is not always the case that people who smoke will suffer from lung cancer, the risks are higher for those who smoke routinely [Rebuttal].
You may also want to learn more about how to write a Rogerian Argument. You can also try a Toulmin Argument sample, how to write a Toulmin argument, or learn more about Classical Argument.
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A rebuttal (R) acknowledges limitations of the argument and may be put forward to indicate conditions in which the warrant is not applicable and consequently the conclusion can be overturned.
A rebuttal in the case of Mrs. Smith may be that she is currently on a medication that interacts with hydrochlorothiazide. A more efficacious medication may be suggested and thus act as a rebuttal. Perhaps Mrs. Smith's particular set of values, whatever they may be, prevent her from using the medication.
With the introduction of qualifiers and the search for counterclaims and rebuttals, the Toulmin model can be used to analyze more complex Stage 3 and 4 arguments such as those commonly encountered in the practice of medicine.
Currently there is much controversy among the proponents and critics of evidence-based medicine in regards to the role of external evidence, individual clinical expertise and data from the individual patient in the clinical decision making process. Harley Dickinson has illustrated the role of such information in the clinical context through the use of Toulmin model of argumentation.
Dickinson argues that when introduced in argument information can either be "warrant-using" or "warrant-establishing".
Warrant-using information acts as the basis for a conclusion and attempts to answer "What information do you have to go on?". In the clinical context, warrant-using information relates to the individual patient and is obtained through the patient interview, physical examination and investigative tests. In the case of Mrs. Smith, warrant-using information would include the measurement of her moderately elevated blood pressure on physical examination.
Warrant-establishing information serves as the backing or justification of the warrant used to make the leap from the data to the conclusion. Essentially, this form of information is used to answer "How did you get there?". In relation to evidence-based medicine, warrant-establishing information is typically derived from systematic research such as randomized controlled trials and meta-analysis. However, clinicians may often find themselves in situations where there is little, if any, research data available. In such situations clinicians may use clinical expertise as their warrant.
In the case of Mrs. Smith warrant-establishing information would include randomized controlled trials that demonstrate the effectiveness of hydrochlorothiazide in lowering blood pressure.
Research evidence does not necessitate a clinician to make a particular decision. Evidence is not the absolute truth as it relates to the particular group of people participating in research studies. When we generalize from evidence obtained from a study to our patients we are simply improving our confidence in using a particular warrant.
Hierarchy of Evidence
Preference and greater weight is given to studies with less apparent bias such as randomized controlled trials and meta-analysis. Separate hierarchies of study designs have been developed for therapy/prevention, prognosis and diagnosis. Of the five levels of evidence, level I evidence is considered the freest of bias. Physicians should look to use the highest available evidence from the hierarchy.
The Centre for Evidence Based Medicine provides a document discussing the hierarchy of evidence and grades of recommendation.
Case One - Acute Bronchitis and Antibiotic Use
Ms. Carter, a 54-year-old non-smoking woman, presents with acute bronchitis and requests antibiotic therapy. Her condition is most likely viral in etiology and you deny her request for antibiotic medication. You develop a treatment plan focussed on supportive measures.
She demands an explanation for the treatment plan you've developed. You inform her that antibiotics are ineffective in treating acute bronchitis of viral etiology.
She still insists on you prescribing the medication and says that she always gets antibiotics when she is sick and they always make her feel better. In support of your warrant you refer to the findings of several clinical and basic science studies and discuss how prescribing antibiotics in this situation could help promote the proliferation of antibiotic resistant bacteria.
Case Two - Esophageal Cancer
Mr. Jones, a 68-year-old smoker, has come to your office today to learn the results of a series of diagnostic tests that were performed recently. You inform him that the test results are indeed positive for esophageal cancer and that it is well developed. You discuss his prognosis and outline a treatment plan. As his cancer has become well developed you propose that the mainstay of his therapy be pain management.
Mr. Jones understands that he has cancer but is confused as to why he can't undergo surgery or chemotherapy as treatment options. He asks you why the cancer won't be treated directly. In essence, Mr. Jones is asking you to provide a rationale or warrant for your decision. You may respond that "Esophageal cancer that is as well developed as his is usually terminal".
Mr. Jones may question your warrant by asking "How do you know that?". You are being requested to provide backing to your warrant. Mr. Jones is not interested in warrant-using information but rather warrant-establishing information. You may respond by referring to research studies that show no statistically significant differences in survival rates among men his age and with condition receiving treatments such as chemotherapy, surgery and radiation when compared to pain management.