Is the Prisoner’s Dilemma an Adequate Concept for Ethical Analysis in Healthcare? An Original Institutional Economic Rejoinder

In a recent manuscript, Rogowski and Lange (J Bus Ethics 177:63–77, 2022) evaluate whether the prisoner’s dilemma can be used as a legitimate framework with which to examine health-related economic ethics decisions. In this commentary, I build upon Rogowski and Lange (J Bus Ethics 177:63–77, 2022) using the original institutional economics literature to argue a more subtle, but critical point. Except in extreme circumstances, the use of the prisoner’s dilemma does not qualify as a legitimate, comprehensive framework in which to address most health-related economic ethics problems. Indeed, the intentional characterization of the prisoner’s dilemma as a robust health economic ethics framework is often used to mask the absence of a formal ethical framework. However, this distinction may provide a more concrete, and appropriate, justification to use the prisoner’s dilemma to assess a wider array of health-related economic ethics problems.