<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2072-8174</journal-id>
<journal-title><![CDATA[Revista del Nacional (Itauguá)]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Nac. (Itauguá)]]></abbrev-journal-title>
<issn>2072-8174</issn>
<publisher>
<publisher-name><![CDATA[Hospital Nacional (Itauguá)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2072-81742024000300197</article-id>
<article-id pub-id-type="doi">10.18004/rdn2024.dic.03.197.212</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Ética Clínica, Social y de Salud Pública: reflexiones y desafíos en la atención a dilemas éticos]]></article-title>
<article-title xml:lang="en"><![CDATA[Clinical, Social and Public Health: reflections and challenges in addressing ethical dilemmas]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cabral de Bejarano]]></surname>
<given-names><![CDATA[María Stella]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Recalde Ibarra]]></surname>
<given-names><![CDATA[Felipe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez Núñez]]></surname>
<given-names><![CDATA[Imelda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Itapúa Escuela de Posgrado ]]></institution>
<addr-line><![CDATA[Encarnación ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Instituto Nacional de Salud ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Comité Nacional de Bioética del Paraguay ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<volume>16</volume>
<numero>3</numero>
<fpage>197</fpage>
<lpage>212</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2072-81742024000300197&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2072-81742024000300197&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2072-81742024000300197&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  este estudio vincula premisas y fundamentaciones éticas, para el análisis de dimensiones involucradas en el diseño de políticas públicas de salud y reformas de salud, desde la perspectiva social, del ámbito clínico y de salud pública.  Metodología:  se utilizaron recursos tecnológicos y plataformas de búsqueda, aplica criterios de inclusión y exclusión para seleccionar artículos originales relevantes, a través de revisión sistematizada de la literatura, en bases de datos Medline, Ibecs, Pubmed, Scielo, BVS, Scopus, Web of Science, en inglés y español, acerca de la ética desde la perspectiva clínica, social y de la salud pública, organizando la información en tablas científicas.  Resultados:  las condiciones de vida digna de individuos de cualquier estrato social, se relacionan a las garantías de atención sanitaria y preservación de condiciones de vida que impactan directamente en la salud y el bienestar, debiendo ser respaldados por las instituciones y la sociedad.  Conclusión:  los marcos regulatorios, conectados a los derechos humanos, deben garantizar el acceso equitativo a la atención a la salud, sin discriminación, en el marco de la participación comunitaria, la privacidad y el dialogo social, influyendo en la formulación de políticas, la rendición de cuentas, la prevención de conflictos de interés y la evaluación continua de la efectividad, conducentes al más alto impacto de las intervenciones en salud.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: this study links ethical premises and foundations to analyze the dimensions involved in the design of public health policies and health reforms from a social, clinical and public health perspective.  Methodology: technological resources and search platforms, applications of inclusion and exclusion criteria were used to select relevant original articles, through a systematic review of the literature, in Medline, Ibecs, Pubmed, Scielo, BVS, Scopus, Web of Science databases, in English and Spanish, about ethics from the clinical, social and public health perspective, organizing the information in scientific tables.  Results: the decent living conditions of individuals from any social stratum are related to the guarantees of health care and preservation of living conditions that directly impact health and well-being, and must be supported by institutions and society.  Conclusion: regulatory frameworks, connected to human rights, must guarantee equitable access to health care, without discrimination, within the framework of community participation, privacy and social dialogue, influencing policy formulation, accountability, prevention of conflicts of interest and continuous evaluation of effectiveness, leading to the highest impact of health interventions.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[ética]]></kwd>
<kwd lng="es"><![CDATA[salud pública]]></kwd>
<kwd lng="es"><![CDATA[pandemia]]></kwd>
<kwd lng="en"><![CDATA[ethics]]></kwd>
<kwd lng="en"><![CDATA[public health]]></kwd>
<kwd lng="en"><![CDATA[pandemic.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Miranda]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Criterios de justicia para la asignación de recursos médicos escasos en situaciones de pandemia]]></article-title>
<source><![CDATA[Revista Veritas]]></source>
<year>2021</year>
<volume>49</volume>
<page-range>55-70</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hirsch]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ética profesional: algunos elementos para su comprensión]]></article-title>
<source><![CDATA[Revista Galega do Encino]]></source>
<year>2004</year>
<volume>43</volume>
<page-range>169-79</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Daniels]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<source><![CDATA[Health care needs and distributive justice. En: Justice and Justification]]></source>
<year>2010</year>
<page-range>146-79</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Emanuel]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Persad]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Upshur]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Thome]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Parker]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Glickman]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fair allocation of scarce medical resources in the time of Covid-19]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2020</year>
<volume>382</volume>
<numero>21</numero>
<issue>21</issue>
<page-range>2049-55</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gostin]]></surname>
<given-names><![CDATA[LO]]></given-names>
</name>
<name>
<surname><![CDATA[Hodge]]></surname>
<given-names><![CDATA[JG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[US emergency legal responses to novel coronavirus: balancing public health and civil liberties]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2020</year>
<volume>323</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>1131-2</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<collab>Organización Panamericana de la Salud</collab>
<collab>Organización Mundial de la Salud</collab>
<source><![CDATA[Taller sobre creación de mapas de evidencia para la toma de decisiones en políticas de salud pública]]></source>
<year>2023</year>
<publisher-loc><![CDATA[Ginebra ]]></publisher-loc>
<publisher-name><![CDATA[OPS/OMS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cabral Schveitzer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Mendes Abdala]]></surname>
<given-names><![CDATA[CV]]></given-names>
</name>
<name>
<surname><![CDATA[Schlechta Portella]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Ghelman]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Traditional, complementary, and integrative medicine evidence map: a methodology to an overflowing field of data and noise]]></article-title>
<source><![CDATA[Rev Panam Salud Publica]]></source>
<year>2021</year>
<volume>45</volume>
<page-range>1-5</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schlechta Portella]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Ghelman]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Mendes Abdala]]></surname>
<given-names><![CDATA[CV]]></given-names>
</name>
<name>
<surname><![CDATA[Cabral Schveitzer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evidence map on the contributions of traditional, complementary, and integrative medicines for health care in times of COVID-19]]></article-title>
<source><![CDATA[IIntegr Med Res]]></source>
<year>2020</year>
<volume>9</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>100473</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saran]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evidence and gap maps: a comparison of different approaches]]></article-title>
<source><![CDATA[Campbell Syst Rev]]></source>
<year>2018</year>
<volume>14</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-38</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martín]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[Dufour]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Martín]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Introducción al análisis de políticas públicas]]></source>
<year>2013</year>
<publisher-loc><![CDATA[Florencio Varela ]]></publisher-loc>
<publisher-name><![CDATA[Universidad Nacional Arturo Jauretche]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Abadi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Hatrick]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Paniagua]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Impactos microeconómicos de los programas de financiamiento público para pymes en América Latina.: ¿Qué sabemos?]]></source>
<year>2022</year>
<publisher-loc><![CDATA[Caracas ]]></publisher-loc>
<publisher-name><![CDATA[CAF]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Amaya]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<source><![CDATA[Evaluation of public policies and programs: a contribution to the enhancement of the state]]></source>
<year>2016</year>
<publisher-loc><![CDATA[España ]]></publisher-loc>
<publisher-name><![CDATA[Universidad Autónoma de Barcelona]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rothstein]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Should Patients Control Access to Their Medical Records?]]></article-title>
<source><![CDATA[The American Journal of Bioethics]]></source>
<year>2009</year>
<volume>9</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>4-12</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Veatch]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Foundations of Medical Ethics]]></article-title>
<source><![CDATA[The Doctor-Patient Relationship]]></source>
<year>1981</year>
<page-range>47-75</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bayer]]></surname>
<given-names><![CDATA[RB]]></given-names>
</name>
</person-group>
<source><![CDATA[Ética de la salud pública: teoría, política y práctica]]></source>
<year>2007</year>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nutton]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<source><![CDATA[Medicina Medieval y Renacentista]]></source>
<year>2006</year>
<page-range>387-408</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nohama]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Soares da Silva]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Simão-Silva]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[COVID-19 bioethical challenges and conflicts: global health context]]></article-title>
<source><![CDATA[Rev]]></source>
<year>2020</year>
<volume>28</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>585-94</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[García-Huidobro]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Alcances de la responsabilidad moral por la acción terapéutica]]></article-title>
<source><![CDATA[Rev. méd. Chile]]></source>
<year>1999</year>
<volume>127</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>989-95</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Landeros - Olivera]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Arroyo-Cruz]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Hernández]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Formulación de políticas públicas en salud durante la pandemia de COVID-19 en países americanos]]></article-title>
<source><![CDATA[SANUS]]></source>
<year>2020</year>
<volume>16</volume>
<page-range>1-10</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rubio]]></surname>
<given-names><![CDATA[RD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Visión holística de la bioética en la pandemia COVID-19]]></article-title>
<source><![CDATA[Acta Colombiana de Cuidado Intensivo]]></source>
<year>2022</year>
<volume>22</volume>
<page-range>79-92</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gostin]]></surname>
<given-names><![CDATA[LO]]></given-names>
</name>
<name>
<surname><![CDATA[Wiley]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Governmental public health powers during the COVID-19 pandemic: Stay-at-home orders, business closures, and travel restrictions]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2020</year>
<volume>323</volume>
<numero>21</numero>
<issue>21</issue>
<page-range>2137-8</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hirsch]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ética profesional. Algunos elementos para su comprensión]]></article-title>
<source><![CDATA[Revista Galega do Ensino]]></source>
<year>2004</year>
<volume>1</volume>
<numero>43</numero>
<issue>43</issue>
<page-range>169-79</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gillon]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Medical ethics: four principles plus attention to scope]]></article-title>
<source><![CDATA[BMJ]]></source>
<year>1994</year>
<volume>309</volume>
<numero>6948</numero>
<issue>6948</issue>
<page-range>184-8</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cortina]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Conill]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[10 palabras clave en ética de las profesiones]]></article-title>
<source><![CDATA[Editorial Verbo Divino]]></source>
<year>2000</year>
<page-range>13-28</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Macklin]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Autonomy, vulnerability, and informed consent]]></article-title>
<source><![CDATA[The Hastings Center Report]]></source>
<year>2003</year>
<volume>33</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>34</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mazo Álvarez]]></surname>
<given-names><![CDATA[HM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La autonomía: principio ético contemporáneo]]></article-title>
<source><![CDATA[Revista Colombiana de Ciencias Sociales]]></source>
<year>2012</year>
<volume>3</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>115-32</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[López Calva]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ética profesional y complejidad. Los principios y la religación]]></article-title>
<source><![CDATA[Perfiles Educativos]]></source>
<year>2013</year>
<volume>XXXV</volume>
<numero>142</numero>
<issue>142</issue>
<page-range>1-10</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
