Date of Award

Fall 2020

Document Type

Open Access Dissertation



First Advisor

George Khushf


This project is the first large-scale and systematic effort to bridge the fields of commons research and biomedical ethics, with the aim of furthering key debates in both areas of inquiry. The aims and contributions of the project are twofold.

First, I argue that commons research is valuable to bioethics, because it provides a language to talk about health care institutions. I critically discuss commons research’s main conceptual tools in the context of health care: the Institutional Analysis and Development (IAD) framework, the design principles of successful commons, parallel experimentation, and polycentric governance regimes. This conceptual apparatus can help to advance longstanding arguments in biomedical ethics, particularly when it comes to the challenge of governing scarce resources. The project contributes to two arguments in particular: (1) I explore the possibility of a tragedy of the health care commons, providing arguments in favor of such a tragedy, and considering objections against it. (2) I integrate commons research with Norman Daniels’ theory of justice for health care and the accompanying Accountability for Reasonableness (A4R) approach, arguing that commons institutions are particularly suitable to put Daniels’ approach into practice.

Second, I provide a philosophical and normative analysis that advances NIE and commons research. My contributions are the following: (1) I critically discuss the concepts of institution, organization, and common-pool resources. (2) I provide the most detailed analysis of the design principles of successful commons institutions available in the literature. (3) I relate the commons to the pluralist tradition in liberalism to show the role they can play in safeguarding free health care systems. (4) I assess Ostrom’s proposal to develop polycentric governance regimes in the context of health care. Beyond philosophical reflection on the commons, biomedical ethics can further undertheorized areas of commons research, particularly the development of a theory of justice for the commons. I argue Daniels’ theory of justice for health care can supply such an account, and show the A4R approach can be conceptualized as design principles for the development of just health care institutions.


© 2020, Roel Feys

Included in

Philosophy Commons