 This, at least, was the impression given by a diagram appearing in the first edition of the book (Beauchamp &amp; Childress 1979: 5), which many took to endorse such a top down model. The approach was met with resistance, with those in favor of case-based reasoning (also known as casuistry) objecting to what at least appeared to be a unidirectional movement from principles to cases. Intuitive, case-based judgments seemed to be left out of the picture, and the possibility of a dialectical relationship between principles and our responses to cases ignored. In fact, and as a result of an evolution of their approach, Beauchamp and Childress now fully ascribe to this position on the reciprocal relationship between our responses to cases and moral principles. This is evidenced by their current commitment to reflective equilibrium as the methodology of bioethics. Briefly, reflective equilibrium is a process by which our considered responses to actual cases influence our moral principles, and those improved-upon principles then provide enhanced guidance for our response to further cases. This is a way of doing moral philosophy originally formulated by Rawls (Rawls 1971: 48–51; Daniels 1979; Arras 2007: 47). Cases and principles work in tandem, then, as opposed to moral principles being applied deductively to cases. A distinction is made between narrow and wide reflective equilibrium. Narrow reflective equilibrium involves interplay between our responses (or intuitions) about cases and the moral principles used to structure such intuitions, as explained above, where wide reflective equilibrium brings in additional moral and social theories. Beauchamp and Childress endorse wide reflective equilibrium (Arras 2017: 182).