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Bioethics: A "New" prudence for an emergent paradigm?
by Sharon L. Bracci Stephen Toulmin has pioneered what is by now a familiar view of medicine as a fundamentally moral enterprise. Argumentation theorists will recognize Toulmin's (1981) attention to bioethical discourse that attends value-laden medical practice as one aspect of his broader project to theorize viable models of practical reasoning to supplant abstract modes of formal logic. Toulmin's focus on the ethical issues surrounding contemporary medicine serves to highlight bioethical discourse as an important context for applying practical reasoning principles. (1) This attention to bioethics intersects argumentation scholars' long-standing interest in how the field can contribute to theoretical and pragmatic understandings of deliberation, how argumentation can serve as a tool in effective and ethical decisionmaking. Bioethics, positioned as a paradigmatic case of practical moral reasoning, offers scholars a prism through which to theorize argumentation tools in the service of justificatory deliberative practices. In this essay, I begin from Toulmin's significant insights into the relevance of bioethical discourse for practical reasoning models of argumentation to make a two-pronged claim: One, although Toulmin has directed important theoretical attention to a bioethical model, I will argue that he, with Albert Jonsen, has focused too narrowly on casuistry, or case morality, as the appropriate mode of reasoning within that model. While bioethical deliberations appropriately attend to case particulars and contingencies when deciding high stakes, technologically-driven, and value-laden issues, any focused attention on casuistry faces considerable limitations. These shortcomings relate to particular understandings that Toulmin and Jonsen hold of casuistic practice and bioethics practitioners. I hope to show that casuistic reasoning as a favored mode of bioethical reasoning suffers from its connection to classical phronesis, which gives rise to some untenable assumptions for contemporary bioethical and practical reasoning. These include the view that relevant cultural norms are stable as they apply to particular cases, that sufficient settled convictions exist to form a consensus on key deliberative points, and that the phronimos' "practiced eye" of experience provides a trustworthy and sufficient guide to ethical deliberation through practical wisdom. If casuistry is limited by its classical connections to phronesis, what might successful deliberation look like in contemporary bioethical contexts? In a second claim, I call for bioethical reasoning to exploit an even greater role for narratively-informed dialogical virtues to sketch a model of it. These virtues do not merely elicit a data base for analogical reasoning in deliberation; they also, I will argue, forge a crucial dialogical link to an expanded field of experiential wisdom and understanding. An increased focus on dialogical virtues shapes a "new" phronimos for the bioethical model, one whose practiced ear is cultivated through deliberative patterns that are themselves a practice of ethical activity to enlarge deliberators' critical thinking through self scrutiny and moral imagination. (2) This expanded view of the prudential deliberator better serves an expansive bioethical discourse that is built on conflict, is not sustained by consensus, and is an exemplar for broader theoretical inquiry into practical moral deliberation. To defend these claims of limitation and reformulation, I have organized the essay into three sections: First, after an introduction to the contested nature of the term "bioethics" itself and implications of that conflict for deliberation, I offer some theoretical and methodological connections between casuistry and prudence. Next, I look to a well publicized bioethics case. Through the case I speculate that bioethics' increased focus on casuistic reasoning has limited justificatory value because it is heavily reliant on a straightforward recovery of classical prudence to guide its practice. If the case bears out this speculation, then the case also provides an impulse to theorize an expanded model that more fully exploits the value of case-based reasoning. In a third section, I propose dialogical virtues in the service of a "new" prudential deliberator. Virtues of balanced partiality, reciprocity, moral imagination, and prudential listening, I hope to show, address the unwarranted assumptions regarding exper iential wisdom that weaken the potential moral force of casuistic reasoning in bioethics today. BIOETHICAL DISCOURSE: FIRST FORMULATIONS AND EMERGENT MODEL It is useful to summarize some distinctions between early bioethical discourse and the emerging model to recall the inherently contested nature of bioethics and the discourse that comprises it. "Bioethics," a truncated term for biomedical ethics, has been subject to disputed meanings since it was coined. The first use of the term bioethics is attributed to Van Rensaelaer Potter who, in a 1970 article entitled "Bioethics, the Science of Survival," used it to describe and evaluate interactions among human, animals, and the environment (Reich, 1995; Rothman, 1991). "All of them involve bioethics," Potter argued, since "survival of the total ecosystem is the test of the value system" (1970, 127). But other powerful voices reframed the term to more narrow understandings. In 1971, Georgetown University accepted a $1.35 million grant from the Kennedy Foundation to create an institute that would join biology with ethics, to "put theologians next to doctors." The impulse behind this formulation was a well-publicized case of an infant with Down's syndrome who died, unattended, in deference to parental wishes, in Johns Hopkins University Hospital. Early on, then, the neologism was redefined to include bedside medical issues to be resolved by specific practitioners. Bioethical discourse in philosophy, religion, and law dominated during this first formulation of the term and expanded its purview to examine ethical issues in research as well as clinical practice. Reasoning focused on deontological, utilitarian, and natural rights theory as well as the four bioethical principles of justice, autonomy, beneficence, and nonmaleficence (Beauchamp & Childress, 1994). This is the bioethics environment Toulmin and his colleague Albert Jonsen came to prominence in when they sat together from 1975 to 1978 on a national commission to study human subject research norms. This experience drives their interest in reviving casuistry in bioethical deliberations as a viable alternative to principled approaches that had failed to forge a consensus in health care contexts on philosophical or religious grounds (1988, vii; also Toulmin, 1981; Jonsen, 1991). Today, bioethics continues to push contentiously toward Potter's sweeping view, both in the issues engaged and the range of participants to the discourse. The proliferation of bioethics centers and ethical institutes, real and virtual via internet sites on practical ethics and alternative medicine, attests to this contestation. Bioethics has emerged as a much wider interdisciplinary field to include scholars whose intellectual projects and methods of inquiry are vastly divergent. These include academics and practitioners in law, medicine, nursing, social work, genetic counseling, moral philosophy, moral theology, cultural and medical anthropology, public policy, psychology, literary studies, cultural studies, women's studies, communication studies, and environmental studies. Voices from the allied sciences as they relate to medicine include biology (especially genetics), epidemiology, veterinary medicine (especially animal behavior) and neuroscience. The emerging model is increasingly diverse and divisive, re flecting the same skepticism toward the argumentative force of monistic theories and principled accounts that pervades, in varying degrees, the fields and disciplines that comprise it. Ideological struggles between the individualistic assumptions of the early reasoning and emerging communitarian and family concerns have also expanded the dialectical dimensions of bioethical reasoning. This is particularly salient as the tensions between an ethics of autonomous strangers and an ethics of socially situated intimates are made more explicit (Reich, 1995; Crigger, 1996; Potter, 1999; Nelson, 2000; Zussman, 2000). Put another way, the term is expanding to reflect and accommodate a wider range of interested voices who will be heard; it stands as an exemplar of the larger contest over justifiable forms of practical reasoning in value-laden contexts today. Bioethics is built on conflict, and seeks resolution of issues through justification, not consensus, since these disparate voices have failed to locate shared first principles to adjudicate their differences. The moral weight of particular decisions rests on deliberation that can justify choice, not full agreement. Deliberation on intractable bioethical issues, "cannot make incompatible values compatible" as Gutmann and Thompson note, but it can work to scrutinize and refine particular and shared understandings. How well deliberators recognize, scrutinize, and understand multiple perspectives through their engagement with one another is "at least as important as the conclusion" deliberators reach (1997, 39-40; 1996). CASUISTRY AND PHRONESIS Ongoing disaffection with principled approaches to bioethical issues partially explains the attention paid to casuistry when confronting the constraints of clinical urgency, prognosis uncertainty, clashing values, and crises of conscience (Arras, 1991). An added deliberative value, Jonsen and Toulmin (1988) argue, is casuistry's connection to Aristotelian practical wisdom. Both phronesis and casuistry isolate discernment as their central wisdom, derived from the practiced eye of experience. Casuistic wisdom is the habituated ability to see the relationship between rule and case by locating some degree of paradigmatic or analogical fit across cases. In contrast to a "top down" effort to locate a relevant principle and apply it to a case, casuistic reasoning remains "close to the ground," that is, more focused on case particulars. Casuistic reasoning enables deliberators to explore medical indications, patient preferences, and quality of life concerns to resolve ethical issues (Jonsen, 1991). The practical wisdom of casuistic discernment draws on Aristotle's theoretical distinctions between scientific knowledge and practical wisdom (Nicomachean Ethics, 1990). Practical reasoning concerns itself with things that are capable of being otherwise; people of practical wisdom, phronimoi, are skilled in arriving "by calculation at the best of the goods attainable" in the circumstances before them (VI.vi-vii.6 ). They employ prudential reasoning to arrive at a "knowledge of particular facts even more than knowledge of general principles" to locate the "right conclusion on the right grounds at the right time." Prudent deliberations lead to probable truths, "what all believe to be true" with respect to conclusions, grounds, and timeliness (VI.ix.6). Prudence suggests a wisdom habituated over time, a way of becoming wise by profiting from one's experience. In the Aristotelian scheme of prudential reasoning, principles continue to exert modest ethical weight in decisionmaking as "rules of thumb," as Martha Nussbaum (1986) termed them. They remain "useful for purposes of economy and aids in identifying the salient features of the particular case." These rules of thumb give "normative force" to past decisions, but cannot be applied unreflectively to the case at hand (299-300). Prudence, if it is to remain prudence, must remain a sketch, to be filled in with the character and practice of those who are wise by experience (312-13). Aristotelian prudence is the practiced eye of experience. Casuistry is thus indebted to phronesis for its methodological and theoretical assumptions about moral knowledge: casuists must be capable of prudential discernment in classifying and deciding cases, pay particular attention to case details, and locate contingent moral truths in the case rather than in timeless theoretical knowledge. Given the need to address and act in sometimes urgent and usually vexed medical contexts in which a growing perception of an inadequate primciplism exists, it is understandable that efforts to recover casuistic reasoning by phronimoi are afoot. The Community of Prudent Casuists Jonsen and Toulmin (1988) construct a contemporary secular clericy of phronimoi who have engaged in bioethical reasoning since bioethics' first formulations were established. They note that in "bioethics, the institutions capable of supporting casuistry have come into being. A number of scholars in philosophy, theology, law, and medicine have become interested in the problems of medical ethics and have devoted attention to the analysis of various points." Moreover, institutions such as The Hastings Center and The Kennedy Center for Bioethics have become the "modern analogues of the clerici and the universitates" (339). Jonsen and Toulmin also observe that bioethical dialogue takes place in "an environment of intense public concern," which a new casuistry can serve by habituating Aristotle's "large-spirited," experientially wise person who "is the hero of his Nicomachean Ethics" (404). Contemporary casuistry is not a matter of drawing formal deductions from invariable axioms, but of exercising judgment--that is, weighing considerations against one another. It is a task not for clever arguers but for the phronimos (or "sensible practical person") and the anthropos megalopsychos (or "large spirited human being") (341). Jonsen and Toulmin point to a different kind of argumentative practice to inform case-based reasoning. Bioethical deliberation, they insist, is not so much a debate between "clever arguers," but a practical deliberation among a corps of experienced men and women of good faith and intellectual modesty. Casuistry, they conclude, is the appropriate deliberative tool of this biaethical clergy. CASUISTRY'S METHOD Casuistic analyses begin from a corpus of paradigmatic cases that carry presumptive moral weight in decisionmaking, barring exceptional circumstances. These type cases mark the cultural boundaries of moral choice. For example, the willful, arbitrary killing of an infant is presumptively wrong. A defense of a particular case of killing would carry an argumentative burden of proof to show that mitigating circumstances establish the case as too removed from the paradigm to fall under it and so must be decided on other grounds. Jonsen and Toulmin agree that type cases, or "ultimate particulars" as Aristotle called them, don't take deliberators very far because they speak to one issue; morally vexed cases are generally problematic precisely because they involve a range of issues that do not fall under one type. Even so, the paradigms articulate a range of accumulated experiential wisdom on some valued good; as such, they do important work by defining the outer cultural boundaries of ethical practice. In case-based moral reasoning, casuists begin by taking note of these paradigmatic boundaries. At this juncture substantive questions of fit need to be addressed and mediated. For example, do the circumstances surrounding the death of a particular infant relate only ambiguously or tangentially to a type case? Do several type cases compete for relevance in this particular case? To discern the right fit and mediate among competing paradigms, deliberators draw on their own experiential wisdom to consider the level of marginality and ambiguity of fit as well as the cumulative cultural wisdom embodied in type cases. Once fit is determined, the casuist locates and negotiates patient and physician preferences. But the heart of the method is the analogical reasoning to type the case in a way that helps resolve a crisis of conscience precipitated by ethical issues arising out of the case particulars. In medicine, Jonsen and Toulmin argue, this practical experience is both personal and collective. On the personal level, the priorities that drive "moral reflection and practice are, in part, outcomes of the lives and experiences of different individuals; but in part, they are also the products of each individual's professional, social background." The cumulative wisdom of medical practice shares with common law "long and rich histories," and is a logical extension of Toulmin's earlier attention to jurisprudential reasoning. From this perspective, a great strength in casuistic reasoning is that a prior set of case resolutions represent the product of evolutionary, collective wisdom that is developed over a long period of time. Individual deliberators can draw sustenance and support from this past and be easy in the knowledge that each new case need not invent morality de novo (314). On this view, contemporary moral reasoning evolves, builds on the past; it does not require and will not profit from a revolutio n against a moral past. Methodologically, case-based moral reasoning is rooted in the polis and ecclesiastical courts, which explains its affinity with prudential and legal reasoning. Casuistry, through its alignment with phronesis, also has epistemological and ethical underpinnings. Epistemologically, casuistic reasoning offers provisional, contingent knowledge for an imprecise moral realm. Ethically, casuistic reasoning has moral weight, because it is practiced by phronimoi who have cultivated the practiced eye of discernment, magnanimous people of good will who have been habituated to seek the good end. With these preliminary sketches of bioethics and casuistry in view, I invite readers to turn to a case. The case is particularly useful because it exemplifies a well-publicized event that raises a particularly vexed and prevalent bioethical issue: what is the appropriate boundary of treatment for premature infants? The case also serves to illustrate some limitations of a casuistry that are grounded in classical prudence and suggests an expanded palette of argumentation tools to guide prudential casuists today. THE CASE OF ANDREW (3) Andrew Stinson was born in a community hospital on December 17, 1976 at a gestational age of 25 weeks and a weight of 800 grams (1 pound, 12 oz.), an extreme end of human viability in the 1970s. His premature birth was precipitated by the hemorrhaging of a low lying placenta (placenta previa). Earlier, Andrew's mother, Peggy Stinson, 34, began to bleed spontaneously. The bleeding led Mrs. Stinson and her husband, Robert, to consider but reject an abortion, a legal option at 25 weeks. Despite bed rest, Mrs. Stinson began a spontaneous labor that resulted in the live birth of Andrew. The Stinsons recalled that they were unsure about how to interpret their experience, what to name it: Was it a failed spontaneous abortion? A "blessed event"? A family "tragedy"? They settled on the term "fetal infant" to describe their son and the experience, reasoning that they had expected an aborted fetus and were unprepared for a live 800-gram infant. The Stinsons' claim that they expressed a wish to the community hospital staff for no "heroic" measures to maintain Andrew's life and with their physician set a conservative course of treatment for him. This course restricted treatment to manual resuscitation should the infant "forget" to breathe (apnea) and protection for his eyes and nervous system in order to give him "a chance to grow" to term. Andrew remained stable for a time but after seven days, on December 24, he experienced fluid imbalance and weight loss to 600 grams. After a meeting between Andrew's parents and his pediatrician, the infant was transferred to an Infant Intensive Care Unit (IICU) in a university hospital in Philadelphia where, the physician suggested, the infant could be "stabilized." Andrew's mother, Peggy Stinson, recorded, frustration with the decision to move Andrew: "Something has just moved quickly past us, but it could hardly be called a choice." In the IICU, Andrew was placed on a ventilator, a move the Stinsons maintain was against their wishes. Over the next six months the infant remained ventilator dependent. During this period Andrew developed several conditions, many of which were iatrogenic. According to his medical records, as reported by the Stinsons, Andrew developed bronchopulmonary dysplasia (ventilator lung syndrome), retroiental fibroplasia (blindness), recurring infections, demineralized and fractured bones, iatrogenic cleft palate, pulmonary artery hypertension, and brain seizures associated with his diseased lung. He also experienced persistent bloodstream infection related to arterial line sites, which led to gangrene and necrotic muscle extending to the bone in one leg; a urinary tract infection; a pulmonary hemorrhage; and, multiple courses of pneumonia. He had episodes of bradycardia and cyanosis and underwent numerous suctionings, tube insertions, blood samplings, and transfusions. Since he was at an extreme end of viability, eff orts to stabilize Andrew's nourishment through a hyperalimentary diet were necessarily experimental, and contributed to rickets and bone deterioration. Andrew's parents claim that they made repeated requests to stop what they viewed as ineffective and painful life prolonging measures; the attending physicians (three, who rotated charge of the IICU) reportedly maintained that the infant was "salvageable." The physicians noted that the medical technology to save Andrew was so new as to make outcomes unpredictable and explained to the parents that "We don't have the answers because we are on a frontier here." Communication between the Stinsons and the physicians was emotionally charged. The Stinsons record that when asked about removing the infant from the ventilator one physician replied, "What do you want me to do? Go in and put a pillow over his head?" Another physician reportedly responded: "Hospital policy is to obtain a court order when parents don't agree....These babies are precious to most parents." A third attending physician reputedly categorized the Stinsons' opposition to the ventilator and "heroic" measures as evidence that they were "bad parents." Parent/physician interaction was complicated by the monthly resident rotations. The Stinsons recalled that they were characterized in the medical records early on as "difficult," "not cooperative," "callous," "insensitive," and "wanting their baby to die," which prejudiced their ongoing interactions with successive house staff. Over time, as prognoses became increasingly bleak, the physicians reached a consensus that Andrew probably "would not survive his hospitalization." They agreed that the next time the infant dislodged his breathing tube they would wait to see if he could breathe on his own, rather than reintubate him immediately. If he could breathe, even for a brief time, the physicians would declare him legitimately weaned and no longer a candidate for mechanical ventilation. They reasoned that, in this fashion, Andrew would not die as a direct result of removing the ventilator. On June 14, 1977 Andrew dislodged his breathing tube, breathed on his own for a brief time, was declared weaned, and died. After his death, one physician reportedly remarked, "We were all lucky to get out of this as easily as we did." Andrew's parents expressed a different view: We think the question must be raised as to whose interests were served by this hospitalization. Certainly not Andrew's. He had the misfortune of being declared "salvageable" by people who knew neither how to "salvage" him nor when to stop. Certainly not ours. Those six months were for us a nightmare of anguish, frustration, and despair. It seems clear to us that all the benefits in this case went to Pediatric Hospital [fictional name] and its staff. The medical residents got a chance to broaden their education by working with a baby with malfunctions in virtually every system of his body, the specialists took part in some interesting consults and gathered some data, and the hospital collected the mind-boggling sum of $102,303.20 from our insurance company. At the time of Andrew Stinson's birth in 1976, a few well-publicized cases of babies with Down's syndrome and spina bifida cystica dominated bioethical discussions. The previously mentioned Down's syndrome baby at Johns Hopkins who helped to reframe the scope of bioethical reasoning is one example. Yet, as Jonsen later noted (1982), these impaired babies accounted for only a "small fraction" of difficult decisions made in neonatal units. By concentrating on Down's syndrome and spina bifida, the discourse had skirted the "dominant" problem in neonatology: extreme low birth weigh infants who fill most of the cribs in neonatal intensive care units (236-37). Premature infants are not only the most numerous category (1 in 10), they are also the most controversial, since physicians and the public are very divided over treatment options for them (Lantos, 1987). So the Stinson story unfolded in a rhetorical context of professional dissension, public ambivalence, and perplexed silence. Clinically, it emerged in large ly uncharted territory, using powerfully resonant "pioneer" and "frontier" metaphors to describe clinicians breaking new ground in the newly certified subspecialty of neonatology. A Casuistic Approach to the Case A casuistic analysis begins with a detailed description of the case. These include Andrew's medical indications, the ethical issues, and physician and parental preferences regarding treatment. The diagnosis and prognosis are supplemented by family concerns as reported by the Stinsons and recorded and evaluated by the ethicist. The casuist then seeks out relevant longstanding cultural maxims. These will include the deeply rooted belief that parents should have autonomy over their children, a present day remnant rooted in the Roman law of patria potestas, which gave a father life and death powers over his household. The vestigial force of this value survives in the reluctance to intrude on the sanctity of the home, to eschew interference on the belief that parents are responsible for and know best their children's interests. The presumption is that this sanctity provides a spiritual moat around the home and places the burden of proof on those who would cross it. A casuist might also appeal to another relevant maxim, whose roots are Judeo-Christian rather than Greco-Roman. This is the view that all life is precious, since it is formed in God's image. Today this imago Dei notion survives as a sanctity of life principle, an outer cultural boundary that undergirds constitutional protections for all citizens, which begin at birth. Although Mrs. Stinson had a legal right to an abortion at the time of Andrew's gestational age, the conventional wisdom holds that a qualitative shift occurred in rights and responsibilities upon her delivery of a live infant of the same age. These rights and responsibilities suggest other "rules of thumb" within the boundaries of cultural wisdom: beneficence and nonmaleficence. On the one hand, physicians' codes articulate a view that physicians are their patients' advocates and bound to act in their best interests. On the other hand, in so doing they must also observe maxims to "first, do no harm" and "do not kill." The casuist, having located broad background connections to autonomy, justice, beneficence, and nonmalificence would attempt to locate paradigmatic cases, cases Andrew's most resembles. Since the courts were 3 and 4 years away from deciding the Baby Doe cases of Down's syndrome and spina bifida, it would not yet be possible to appeal to a legal exemplar on impaired infants. The Quinlan case, which might provide guidance on the withdrawal of life sustaining equipment, was also several years away. Legal scholars were not addressing prematurity in substantive fashion at this time and Jonsen's own set of neonatal guidelines would not emerge until 1982. The casuist's judgment will therefore be complicated by competing evolutionary views of collective wisdom when families and clinicians engage one another, incompatible presumptions about newborns, and deep cultural ambivalence made more explicit by emerging neonatal technology. So, the casuist must interpret ideologically charged "common sense" in a context of emerging beliefs that may or may not speak to settled convictions with respect to some newborns and against competing bioethical principles. Next, the casuist needs to articulate the relevant characteristics that define this case, locating stasis and defining the key issues or concepts on which the case turns. Here, the casuist could recall the Johns Hopkins case. However, Andrew was neither impaired nor comatose; he was severely underdeveloped, so this analogue may not apply. The casuist will need to judge whether this distinction of underdevelopment makes a morally relevant difference for locating an analogue. If prematurity makes this case qualitatively different from Down's syndrome babies or from others infants on ventilators, the casuist will try to locate other cases of prematurity for some "common sense." In seeking an analogue, Andrew would be compared to other infants whose lives were also imperiled or impaired. Casuists might also appeal to the notion of double effect to interpret the moral import of withholding or withdrawing treatment, a maxim well worked by Jesuit casuists in premodem times. Drawing on this distinction, physicians might be morally justified in withdrawing support to halt iatrogenic harms, without intending, although understanding, that such withdrawal might/will lead to the infant's death. Finally, the casuist considers the patient's best interests, which, in this case is vigorously disputed by the resident physicians and Andrew's parents.
The prudential work, then, includes triangulating a fit among type cases, locating stasis, and negotiating several points of conflict. Resolving cases of conscience is difficult work, a point Arras makes succinctly with the observation that "In hard cases, principles conflict. That is why they are hard" (1994, 995). Since these rules of thumb stubbornly refuse to rank order themselves, the casuist will need to make rhetorical, value-laden judgments at each step of the deliberation. In this case, contested perspectives begin with conflicting conventional wisdom about newborn care set against the uncharted terrain of an emergent neonatology. The blurred boundary line between infant care and clinical research on premature infants is particularly troublesome in IICU nurseries at this time. Decisionmaking is complicated in these contexts by an unsettled cultural wisdom that lags technological innovation. Further, the relative moral weight of competing principles, already ideologically-driven, are passionately cont ested and they compete. Value hierarchies clash in parents' and physicians' disparate preferences to do good and avoid harm, to preserve a life or have a hand in its end to halt further iatrogenic harm, pain, and suffering. Eventually, the casuist will need to decide which particulars of the case are relevant and who should give voice to those particulars. At some point they frame and edit the particulars, deciding what to include, what to leave out, what to record from parents, from physicians, and other hospital staff. Casuistry's Shaky Assumptions While I believe there is considerable value in the casuistic approach, especially in casuistry's explicit focus on case particulars and contingent decisionmaking that honors bioethics' inherently contested nature, it is important to acknowledge the force of its limitations. An underlying source of casuistry's problems is the method's reliance on classical notions of prudence. Supporters have assumed that in rehabilitating casuistry they can recover Aristotelian prudence in relatively straightforward fashion. However, prudential practice in classical contexts involves several erroneous assumptions for contemporary bioethical reasoning. These unwarranted assumptions include the view that relevant cultural norms are stable, that sufficient settled convictions exist to form a consensus on key deliberative points, and that the experience of phronimoi provides a trustworthy and sufficient guide to ethical deliberation. Bioethical discussions of issues that arise at several points along life's continuum from genetic engineering and abortion to physician-assisted suicide and "futility" criteria suggest that several key norms regarding the experiences of birth and death are unstable. Rapidly emerging technological gains exacerbate this instability. They do so by heightening ambivalences and incommensurate values attached to life's continuum that might have remained latent and unchallenged without the technology to force numerous birth and death issues into public view and cribside choices. Moreover, discussions over what to do in the face of unstable norms cannot appeal to settled convictions for adjudication. If anything, the Baby Andrew case posits a surfeit of competing convictions from Greco-Roman and Judeo-Christian legacies. Aristotle's phronimos could locate the "right conclusion on the right grounds at the right time" because he could also locate "what all believe to be true" with respect to the grounds of his deliberative arguments. But if Andrew's parents and caregivers could not locate this grounding on key deliberative points, the casuist should not, a fortiori, expect to find it in the cultural lag between "common sense" and a common law to adjudicate technologically-driven neonatal issues. A third difficulty for recovering classical prudence rests on a crucial assumption that the experientially wise provide a sufficient and trustworthy guide to ethical deliberation. Intuitively, the favorable regard for experiential wisdom has appeal. Many seek out people of experience when facing vexed issues, reasoning that those who have given years of study, serious thought, and extensive practice to the resolution of ethical issues can provide wise counsel. Aristotle described phronimoi in just this way, as those who became wise by profiting from their experience with ethical issues that do not yield to certitude. However, ever-changing technologies and disparities among deliberators' social and intellectual circumstances caution against any set of experiences as sufficient to resolve ongoing, technologically-driven bioethical complexities. Nor is any set of experiences representative of "what all believe to be true." Setting aside the question of whether such representativeness was even possible for Arist otelian pkronimoi, it cannot he today, given that the range of social classes and ethnicities in contemporary society hold different views of medicine and illness. Our views are inescapably partial, limited, biased, and, thereby, untrustworthy. If prudence as the wisdom gleaned from one's experience is insufficient and untrustworthy, it is also unreliable because the concept of "experience" is itself unstable. Conventionally, experience is understood as the events and sensations we take part in, the phenomena of everyday life that contribute to our practical knowledge of the world. Experience, from this understanding, is something people "have." However, emerging scholarship in literature, history, and cognitive science suggest a view of experience as a set of constraints on how we interpret those events and sensations. On this view, experience may be said to have us. The value in "real life" stories of personal experience from this perspective is not for any straightforward connection they have to reality or truth or even authenticity since, on this view, experience bears no such one-to-one relationship to reality. Humans interpret their experience, try to make sense of it within a cultural framework that exists prior to their particular experience in the world. The cultural frame mediates, stands between, individual experience and what is made of it. Peggy Stinson's experience of becoming Andrew's mother, for example, was conditioned by preexisting cultural understandings of what abortion entails, what a baby ought to look like, what physician ethos consists in, what "good" parents are like, what spousal and family needs entail, which social supports should or should not he in place to serve a growing Andrew's needs. The hospital staff who interpreted their experience of attending Andrew as the work of frontier folk were similarly constrained by powerfully seductive cult ural meanings of that image, and what "bad" parenting and good doctoring entails, in light of the metaphor. The casuist's experience is similarly shaped by a set of exposures to particular cases, colleagues, institutional, and professional affiliations that coalesce into a worldview. These prior meanings suggest that experience itself is a "linguistic event," as Joan Scott termed it (1990), which is to say a construction that draws on and is bounded by dominant narratives already in the cultural air before the Stinsons became parents, Andrew's caregivers became pioneering physicians, or casuists joined the ranks of bioethical clerics. This view of experience suggests that virtuous deliberators, however genuinely committed to negotiating the twin goals of medicine and patient needs, cannot rely solely on a conception of casuistry as prudence whose experiential vision limits its argumentative value. Put another way, casuistry's limitation is not in the contingent truths uncovered in its deliberations. Shortcomings center on casuistry's faith in inadequately scrutinized perceptual frames to locate and argue from those truths. It is important to distinguish among the merits of case-based reasoning that attends to particulars, the intellectual modesty and good faith that drive its contingent resolutions, and the unstable experiential wisdom that weakens the moral force of its provisional judgments. Contingency and good faith are not at issue in a critique of casuistry as prudence; blinkered experiential vision among deliberators is. The case of Baby Andrew reaffirms a picture of bioethics as built on conflict, as inherently contested. The case also supports the view that bioethical (3) discourse cannot be sustained by consensus; more modest goals preserve its ability to justify choices. Stasis, which turns on the question of determining the boundary of effective and ethical care for Andrew, suggests a different argumentative focus as well. At its essence, bioethical reasoning over Baby Andrew is less about winning and losing and more about interdependent, nonadversarial deliberation to honor the interests of the parties involved and reach a justifiable decision. Jonsen and Toulmin imply as much when they insist that this is not the work of "clever arguers." Instead, they claim, it is the task of wise deliberators, phronimoi, whose labors reflect Aristotelian virtues of good faith, magnanimity, and practical wisdom. However, the Baby Andrew case suggests that a straightforward recovery of Aristotle's phronimos is insufficient to sustain t he moral force of case-based reasoning and contingent truths. If these observations are plausible, then another question presents itself: which virtues attend a "new" phronimos, and thereby strengthen casuistry? In the remaining section, I propose dialogical virtues as argumentation tools in the service of interdependent deliberation over the case of Baby Andrew and others like it. An expanded palette of dialogical virtues to serve deliberation can do important ethical work if they help to sustain bioethical discourse and lend moral weight to decisions in specific contexts. HABITUATING THE NEW PHRONIMOS Casuistry is fruitful, yet limited. In light of its false grounds for today, theorists can strengthen case-based reasoning with tools that reflect contemporary concerns. The problem with casuistry is not in the contingent nature of its solutions in hard cases of conscience; the problem is in the limited field of experiential vision the phronimos relies on to resolve these increasingly complex situations. That said, it is important to concede that, although the experiential wisdom deliberators possess is inescapably partial, they must, perforce, draw on it. Arguably, the stark necessity of reaching provisional decisions, with wisdom gleaned from imperfect and incomplete knowledge, is the central and poignant burden of bioethical discourse. It is a moral burden best shared by all parties to the discourse. Casuistry in complex, rapidly changing bioethical conflicts is well served by a more rigorously focused interdependent ethic to address its limitations. Dialogical virtues provide useful argumentative tools in this effort, forging a new prudence out of deliberative interdependence. Virtues of balanced partiality, reciprocity, narrative imagination, and critical listening foster a more interdependent ethic, out of which new phronimoi emerge. Balanced Partiality The argumentative task regarding experiential wisdom is neither to eliminate nor perfect it; rather, it is to scrutinize and balance it. Balanced partiality strengthens the moral force of experiential frames by cultivating deliberators' ability to hold their experiential bias and an open-minded sensibility in productive deliberative tension. Balanced partiality is the dialogic capacity of deliberators to remain critically aware of their experiential vision and commitments and "to account for their potential impact" as they strive for morally justifiable resolutions (Makau and Marty, 2001, 56). Balanced partiality acknowledges the need to mediate one's own commitments against broader commitments to fair resolutions. It is this recognition of tempered partiality, not the impossible pose of impartiality or neutrality, Makau and Marty argue, that serves participants in ethical and effective argumentation (79). Balanced partiality is critically self aware of its own cognitive and emotional commitments, even as it strives to remain open to others. As such it depends on a more active engagement of other experiential frames. Since deliberators' inescapable partiality reflects a life of experience that comprises one story out of many possible narratives, a new prudence harnesses the tension in balanced partiality to attend more closely to these limitations. However, the new phronimos cannot rely on a passive, relatively straightforward reception of others. Sharing different experiences may happen to jolt deliberators into the needed access to different experiential frames, but this passive reception is risky because it may not. Contemporary prudential deliberators work toward a more active engagement of others. Wise deliberation seeks out and is receptive to other narratives, exploits the tools of narrative to analyze relevant stories, and draws on ethical listening patterns to habituate patterns of self reflexivity wit h respect to their own responses to stories and narrators. Contemporary prudential deliberators seek out as many relevant stories as possible within their constraints for decisionmaking. This active search extends beyond whatever happens to cross deliberators' ears and beyond the patient and physician preferences in a case. Prudent deliberators would more actively engage the Stinsons, Andrew's physicians, IICU nursing staff, and other relevant narratives, whose "stories" help deliberators become more alert to their own biases that can weaken open-mindedness and unhinge the capacity for balanced partiality. In short, habituating a balanced partiality toward one's own experiential biases becomes a critical argumentation tool for self-scrutiny and helps cultivate a new phronimos who approaches experience as the "beginning not the end of moral deliberation" as Lauritzen put it (1996, 13). Prudence thus becomes less a process of the practiced eye of experience and more a practiced scrutiny of experiences heard from a framework of prior meanings. Hospital staff in a IICU cannot stand in the Stinsons' place, nor can these parents move to the precipitous technological frontier the residents found themselves on at Andrew's birth, but both can reflect more critically on the nature and presentation of their experiences and their role in any evolving accord over treatment decisions. Reciprocity The self-reflexive and critical capacity to hold one's experiential vision in productive tension with others' experiential biases is also a disposition to constrain dialogue around norms of egalitarian reciprocity. Seyla Benhabib, in her construction of a strong conversational model of discursive ethics, identifies this reciprocal capacity as one of the crucial "conversational skills and virtues involved in the ongoing practice of moral dialogue and discourse" (1992, 53). Reciprocity requires that deliberators understand their viewpoint from a multiplicity of viewpoints, that they construe and interpret a particular situation by engaging and giving proportionate weight to all relevant voices. Benhabib notes that humans inescapably make moral judgments out of the phenomena of their lives. With Hannah Arendt, she links these moral judgments to interaction (in Benhabib, 1992, 126-27). For Arendt, human immersion into the social world is a kind of second birth, a "natality" that takes shape as a narrative, a lifestory told through speech and action. This helps us to understand "moral action as interaction" and moral judgment in interaction. The interdependent nature of moral choice derives from the human impulse to understand actions as part of a coherent narrative of present and past identities. Considering how others will view these actions and motivations encourages reflexive understanding of a narrative history that influences judgments. For Benhabib, the springs of justified ethical action are in the enlarged capacity to scrutinize one's narrative self through respectful and critical engagement of other narratives. Echoes of Aristotelian magnanimity and good faith can be heard in this key element of Benhabib's discursive ethic. Locating morally justifiable decisions ultimately requires a predisposition to an open-hearted search for some solidarity of purpose, if not viewpoints. However, deliberators can only get there through a more critical scrutiny of interaction. Moral judgment requires the critical and self-reflexive engagement of plural perspectives, which nurtures the enlarged thinking required of that judgment. The Stinson case revealed a painful lack of effort to engage diverse perspectives as a way to broaden viewpoints and open minds. Deliberation that was capable of reversing perspectives would be more likely to locate some overlapping purposes with respect to the ethical and effective boundary of care for Andrew, even as it grappled with larger epidemiological interest in premature infant morbidity and mortality rates. A more critical and self-reflexive approach to competing narrative constructions of parent ing and clinical caregiving within these purposes would have tempered the adversarial nature of interactions and deflected some of the asymmetrical power relations. Critical perspective-taking would help clarify some solidarity of purpose with respect to Andrew's care, even if it could not reconcile incompatible values. Reciprocity is thus crucially important in bioethical forums, in which deliberation should help "participants recognize moral merit" in alternative views, "clarify what is at stake" and sort out partial from larger interests (Gutmann & Thompson, 1997, 40). Narrative Imagination Balanced partiality and reciprocity require that deliberators exercise their moral imagination through narrative skills. In addition to seeking a range of views, prudent receptivity begins from a baseline of respect and encouragement. Deliberators stand ready to say, "tell me more," a probe that opens up, not a dialectic between competing stories that must be adjudicated, but a wider path to deliberators' moral understanding. Martha Nussbaum's work on the connections between moral understanding and narrative imagination is particularly useful in bioethical crises of conscience. Narrative engagement fosters the capacity to develop a "sympathetic imagination" to grasp "the motives and choices of people different from ourselves, seeing them not as forbiddingly alien and other, but as sharing many problems and possibilities with us" (1997, 85). This receptivity serves deliberators' ability to reverse perspectives through an empathic engagement of others' legitimate emotional commitments. This regard, Nussbaum ins ists, is a critical precursor to negotiating vexed moral issues (2001, 173). Had deliberators in the Baby Andrew case worked harder to engage and understand the emotional underpinnings of their disparate narrative structures with empathic regard, it is more likely that their mutual alienation would also be tempered. In turn, deliberation could more easily shift from a goal to overcome and defeat what each viewed as alien, to a goal of exploiting their disparate views together, as rich resources in a collaborative effort to determine the appropriate boundary of care for Andrew. A narrative imagination thus becomes an argumentation tool in the service of an interdependent ethic because it can help to convert adversarial others into fellow travelers in a more collaborative search for justifiable decisions (Makau and Marty, 2001). Prudential deliberators also exploit the narrative imagination to listen for other plots, other constructions of heroes and villains, different crisis points, and alternative morals to the story. The Stinson narrative reminds us that there is no one, true story to be told; instead, there are several parallel narratives in play. The Stinson narrative recounted a story of parental ambivalence and frustrated parental power when their infant clashed with cultural norms and expectations. Their experience can be read as one chapter in an unfolding story of the broader cultural status of infants. Their version of events, too, is inescapably rhetorical: it is told from a perspective and employs language in ways that communicates a view of things to readers. The Stinsons' purposeful and strategic use of language to describe their experience was designed, from one historian's perspective, "to impart a particular lesson and empower the Stinsons (and patients) against their doctors" (Rothman 1991, 219). Thus, the Stinson story is both a fuller and edited version of events; it offers a cautionary tale for readers to heed: Look what happens when parents' wishes are denied. Rothman suspects that had the baby survived and thrived, the Stinsons' story would have become the physicians' story of a heroic save, a miracle baby. He concluded that "however compelling the Stinsons' narrative, one has only to imagine a different set of circumstances to see its limits" (219). Whether or not the Stinsons were disingenuous authors, or Rothman a tool of powerful interests, his skepticism reminds us that how a story ends helps determine how it is recorded into collective memory for future decisionmaking. Part of narrative's value, then, is to craft a prudence that can imagine these other sets, scrutinize them for the assumptions behind their rhetorical devices, and temper imperfect claims of interestedness and best interest in medical contexts. Mark Johnson lends additional support from cognitive science to argue that moral reasoning is a process of imaginative narrative exploration. Our most basic contact with reasoning, he argues, takes place in a "culturally embedded process of story construction" (1993, 180). Gradually, we look for fit between events and acceptable narratives in some kind of order, the making sense of things Scott invokes us to scrutinize more carefully at the start of deliberation. This search for fit and scrutiny of the fit suggest that deliberators situate their moral reasoning within their narrative understanding. When faced with events and emotions that do not fit, as in the dissonance between the Stinsons' reaction to Andrew as fetal infant and their cultural understandings of birth as blessed event, Johnson suggests that what deliberators need most is the moral imagination to explore the narrative possibilities that contribute to a more defensible decision. The primary forms this moral imagination can take in the deliberation over Baby Andrew and cases like it include scrutiny of the prototypes of experience which, in casuistry, are the type cases. In the Stinson case, this insight includes the grasp of evolving paradigmatic cases to mark the outer boundaries, as Jonsen and Toulmin suggest, as well as a fuller grasp of the narrative structuring of the issues embedded in case descriptions that casuistry attends to in deliberation. However, it is not merely discerning a fit; wise deliberation also profits from a closer look at which values are made salient and which are obscured in type cases. Weighing and discerning what is gained and what is lost, which values are given priority by one image over another of parenting and frontier medicine is important prudential work that provides a fuller scrutiny of the values embodied in these ultimate particulars. Prudential Listening Finally, wise listening as self-reflective and critical action supports the tools of balanced partiality, reciprocity, and the moral imagination. Prudential listening expands the moral imagination by listening for stories as rhetorical constructions of events and the sensations that surround them, not with a view to empty the story of bias, but to negotiate wisely between what is revealed and what is obscured by particular viewpoints expressed in narratives. Prudential listening promotes the "sophisticated readings of cases" that Tod Chambers (1996, 32; 1994) calls for, and exploits narratives' rhetorical qualities to grasp how the data and their framework influence deliberations (Charon, 2000). Habituating a critical and empathic ear helps cultivate the moral imagination of the new phronimoi by "sharpening our powers of discrimination, exercising our capacity for envisioning new possibilities, and imaginatively tracing out the implications of our metaphors, prototypes, and narratives" (Johnson, 1993, 198). Prudential listening patterns that cultivate self reflexivity habituate deliberators' disposition to attend to their own ongoing responses to stories and narrators. Prudential listeners balance, not bracket their responses. Rather than attempt to empty themselves, prudential listeners account for their responses, attend to them, not suspend them. This self-scrutiny of the inevitable biases all interested parties bring to deliberations stimulates a more critical look at how narrators and listeners shape and are shaped by their "real" experiences. Prudential listening confronts the constraints built into claims that begin in, and are grounded in, personal experience. As critical listening works to habituate these other patterns of critical reflection and imagination, listening itself becomes a mark of contemporary prudential practice. Whereas classical prudence both required and nurtured a goal to cultivate a practiced, discerning eye that profited from one's own experience, a new prudence cultivates a practiced ear that profits from access to many relevant experiential frames. Listening as a kind of prudent, ethical action serves to change deliberators by encouraging the continuous development of those dialogical virtues that heighten critical thinking and self-scrutiny. Prudent listening eschews the passive, detached ear that refuses intellectually and emotionally to engage one version of things in relation to others. In the Stinson case, successive attending physicians appeared to be powerfully oppressive in their disengagement, continuing an unscrutinized impression of the Stinsons that protectively cloaked Andrew's caregivers in a particular viewpoint. Their impruden t listening took few risks that might change minds or hearts, was too cautious with respect to a willingness to engage their own and other views. Conversely, prudential listening as a pattern of ethical action that reinforces balanced partiality, reciprocity, and the moral imagination, serves deliberators in bioethical contexts marked by plural and sometimes incommensurable values. Listening as action both honors and strengthens casuistry's acknowledged humility with respect to answers, and is true to norms of intellectual modesty with respect to knowledge claims. Prudential listening strengthens the necessarily interdependent nature of bioethical discourse with a more explicit prima facie regard for the moral merits of others' views. Prudential listening regards other narrative structures as resources for enlarging deliberators' moral understanding, not oppositional views to be overcome. Prudential listening habituates the willingness to take the risk involved in subjecting one's views to scrutiny, to confront the "danger involved in creating a passageway between" people (Bickford, 1996, 153). In talking this risk, deliberators increase the possibilit y of finding a point of contact and moral understanding that contribute to case resolutions. Listening shapes deliberators, but we cannot know in advance exactly how. That is the risk in hearing out another. However, as Arthur Frank reminds us, advantages of listening critically include its humanizing and formative potential. Learning to confront this uncertainty head on is also to uncover "that being human is the perpetual finding out of what is good and virtuous" (1995, 157). These are goals as worthy and crucial today as they were in Aristotle's day. Deliberation in the Stinson case is a process of clarifying for all participants which good and virtuous dispositional traits of deliberation help illuminate how to care for Andrew. Deliberation Toward Justification The Stinson case reaffirms bioethical discourse as built on conflict and sustained by deliberation instead of consensus. Deliberative discourse, in turn, benefits from a more sustained and explicit focus on those dialogical virtues that strengthen casuistry's justificatory power in an interdependent ethic. Narratively informed dialogical virtues of balanced partiality, reciprocity, moral imagination, and prudential listening patterns become argumentation tools that serve collaborative deliberation and justifiable decisions. This is all one can ask of a discourse that confronts incompatible values, deep emotional commitments, and widely divergent worldviews among its participants. The potential merit of these dialogical virtues as argumentation tools is not that they ensure accord on key deliberative points. Their value is in contributing to a deliberative process that leads to decisions of greater moral weight on several bases. These include justification through argumentation practices that can be generally accepted by the participants. In bioethical contexts, the goal is to reach morally defensible decisions rendered more legitimate by the habituation of dialogical virtues practiced by deliberators. Morally justified decisions are better able to withstand scrutiny when arrived at through a critical and self-reflexive process that seeks agreement where it can, and maintains mutual respect when it cannot (Gutmann and Thompson, 1997). The moral weight of decisions also increases when deliberators work toward egalitarian participation. Deliberators are far more likely to adhere to decisions they do not agree on if they have a proportionate voice in the process of deliberation and decisionmaking. Deliberation succeeds, as Bohman observes, "to the extent that participants in the joint activity recognize that they have contributed to and influenced the outcome, even when they disagree with it" (1996, 33). With these tools, bioethical discourse, as a model of an interdependent ethic, improves its prospects for "resolvi ng some of our moral disagreements, and living with those that will inevitably persist, on terms that all can accept" (Gutmann and Thompson, 1997, 41). CONCLUSION I have sketched the contours of an emergent, interdependent model of bioethics built on conflict and incommensurabilities and sustained by deliberation, not consensus. I suggested that argumentation can contribute to the justificatory force of bioethical discourse by theorizing tools in the service of that deliberation. To explore the merits and limitations of existing tools, I looked to the increasing attention to casuistry in bioethical reasoning. Casuistry appeals to many in medical contexts because it offers a thoughtful and pragmatic method for making difficult choices in contexts of uncertainty. It takes individual cases seriously, and is earnest in its attention to particulars. Even so, I have tried to show that contemporary casuistry as a form of Aristotelian phronesis draws on assumptions about shared norms and experiential wisdom that provide shaky foundations for bioethical reasoning today. I have argued that a prudential reliance on the discerning eye of experience is more complicated today. Prudential reasoning should attend to these contemporary complexities, given their considerable ethical implications. Casuistry can benefit from habituating a prudential practice that is more suited to the kind of particularistic moral reasoning it wants to champion by focusing on this larger context of its deliberations, whi ch attention casuists agree is crucial to their work. To meet their own goals and concerns, then, I have advocated that casuists exploit several dialogical virtues to cultivate a prudential practice that is somewhat different from its classical forebears. In sketching the broad contours of a new prudence, I have pointed to ways in which a narratively-informed critical thinking framework of self-scrutiny and empathic engagement shapes a prudence that is itself an ethical activity. I called for particular attention to the habituation of prudential listening practices to scrutinize the complexities of experience. Prudential listening helps cultivate the other dialogical virtues of balanced partiality, reciprocity, and moral imagination in attending to experience. I have focused on narratively-informed dialogical encounters because of narrative's location at the nexus of speaking and hearing, the call readers and auditors hear that invokes their response. This location connects deliberators as both speakers and listeners, it binds them together in a dynamic process with important advantages. Prudential listening patterns within a narrative framework provides a fuller range of perspectives to ameliorate, in part, the tendency to see one's own experience as true and representative, which lessens the likelihood that false consensus or arbitrary willfulness will drive decisionmaking. Listening as prudential action that requires and habituates the other dialogical virtues does important ethical work by adding to the moral weight of casuistry's provisional resolutions. On the classical view, prudence, if it is to remain prudence, must remain a sketch, to be filled in with character and practice. Today, we may want to consider that prudence, if it is to serve practical reasoning in bioethical contexts, should attend more closely to its dialogical frame, whose virtuous patterns of speaking and listening characterize wise storytellers and deliberators alike. (1.) The emergent bioethical model can be seen as the successor to the jurisprudential model advanced by Toulmin and Perelman. The jurisprudential model of contemporary practical reasoning theorizes a "working logic" of argumentation: "Arguments can be compared with law-suits, and the claims we make and argue for in extra-legal contexts with claims made in the courts, while the cases we present in making good each kind of claim can be compared with each other." Toulmin's layout of argument patterns, with jurisprudence in mind, succeeds as informal logic where systems of formal logic fail because it tests arguments against "our actual practice of argument-assessment, rather than against a philosopher's ideal" (1958, pp. 7-10). Chaim Perelman also exploits jurisprudence to revive an explicitly rhetorical understanding of argumentation, and of practical reasoning that emphasizes value judgments and audience (1984, 188-96; Perelman & Olbrechts-Tyteca, 1969). (2.) I place "new" in quotation marks to acknowledge a view of prudence that denotes some very broad understandings of it as a practical capacity to calculate merits and demerits of alternatives prior to action. Rhetorically, I take prudence to be a kind of practical reasoning that is inherently unstable and changing, in order to address the contextual needs of particular, historically situated deliberators. 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