So since I've been leveling a tank, I think the smart thing currently is just to take a quick look over the gear your party members are wearing and made a decision. I did a Bardam's Mettle run last night with a healer in level 210 gear, so obviously I wasn't going to pull big because I knew without asking that the healer wouldn't be able to keep up with the heals needed (despite the obvious annoyance this caused to the DPS in the party)

Conversely I've seen situations where everyone has good gear, I make a large pull, and then burn through all my cooldowns on one pull because nothing is dying, and when I look at my DPS, they're all doing single target rotations. So it's small pulls for the rest of the dungeon.

It was stated well by a previous response to this thread. Big pulls are on everyone in the party to be successful. If all four players aren't willing and able to make them happen, then they're not worth the effort, and you'll get through things faster if you allow your healer more DPS up time than if you make them struggle to keep you alive.