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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The reality has been overwhelmed by the pandemic&#58; tensions between the different national and regional authorities&#44; high costs &#40;still unknown&#41;&#44; constantly changing and contradictory protocols&#44; infection of large numbers of health workers and consequences on individual health and rights not always justifiable&#46; This event do not occur in isolation but linked to economic&#44; political and social processes&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Define a public policy is making a judgment in a context where the results and probabilities are simply unknown&#46; Decisions must be based on the best scientific evidence available&#44; but often there is no evidence&#46; A public health emergency disrupts the normal processes of patient care&#46; An ethically sound framework must balance the duty of care that requires patient loyalty&#44; the alleviation of suffering and respect for the rights and preferences of patients with the duties of promoting equity&#44; public safety&#44; and protecting the health of the community and fairly allocate limited resources&#46; Health care leaders have a duty to plan for the foreseeable ethical challenges&#46; Classification decisions need to be made regarding the level of care&#44; decisions regarding the shortage of personal&#44; space and supplies&#44; safeguard workers and protect vulnerable populations&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Actions on the population&#44; although they are intended to guarantee a benefit for the aggregate health of the community&#44; do not necessarily do so for each person&#44; who must assume limitations on their freedom and personal losses&#46; Public health introduces tensions in people&#39;s autonomy&#46; The concern caused by the imposition of obligations or restrictions on the group of still healthy citizens in name of possible additional improvements&#44; of doubtful benefits or of an uncertain balance between their damages and benefits requires more justification than has been provided&#44; since it leads to interference in elections and personal lives&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> What offers a lot of good to the community can be catastrophic for the individual&#46; It has had a tremendous cost&#58; the victims&#44; those affected by the virus with its morbidity and mortality&#44; and their families&#44; with the consequent economic and social repercussions&#44; the suspension of educational activities and restriction of our personal liberties&#46; So are those who have not received enough attention from the health system due to the amount of resources dedicated to the prevention and control of the epidemic&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical medicine has an ethical contract to care for patients&#44; maximizing beneficence and minimizing maleficence&#44; respecting autonomy and equity&#46; However&#44; public health lacks that consensus&#46; The objectives of caring for the entire population lead the goods of society &#40;the health of citizens&#41; to prevail over the right of people to make their decisions autonomously&#46; Better training and more transparent information can help us&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this context uncoordinated and unusual responses are not surprising&#44; with contradictory interventions that demonstrate the lack of coherence&#46; Coordination mechanisms must be established that do not depend solely on the good understanding of the parties involved&#46; Crises are challenges from which we must learn&#44; with mistakes and successes&#44; since they serve to adjust the devices and refine our response to other future&#44; unavoidable and unthinkable crises&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a> Crises are anything but unexpected&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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