Abstract

The collapse of the health care system and the rationing of health care resources is a dramatic manifestation of the crisis of scarce resources and arguments about just allocation of contested public goods. In these arguments, autonomy, individual rights, and the philosophic claim of entitlement have become central. These concepts of liberal theory themselves have failed; addressing the problem of justice in allocation requires a language of communal responsibility. I propose an ethics of encounter, drawn from an innovative analysis of the story of Ruth and exemplified in the Oregon experiment in health care reform. Liberal theory has failed to provide such language because it does not address the clinical reality of health care, nor describe the lived experience of women, nor present a sufficient view of the nature of the moral agent. Feminist, communicative and communitarian challenges to the liberal tradition insist on respect for community, context, relationship, and on a discursive ethics. While this language is critical, it is not sufficient. Singularly missing in the policy debate is the moral voice of the Jewish textual and historic tradition. I propose that this tradition offers resources for the recovery of a language adequate to the challenge raised by feminists and communitarians. Critical reflection on the Jewish tradition, particularly the works of Emmanuel Levinas, rabbinic texts on rationing, and a new exegesis of the Book of Ruth create the philosophic ground for justice and frame the language for health care reform. ;The Ruth story insists on the primacy and power of women's choices. The text declares necessary the face-to-face encounter, the responsibility for the other, and the engaged discourse of the moral community with the one that is the vulnerable stranger. It demands a language of recognition that the other is the self. This ethics of encounter is represented by the moral communities created in the Oregon health care reform process.