Legislative Constraints and Moral Distress: Reframing Occupational Risks Through a Public Health Ethics Lens

This Case for Discussion examines legislative constraints as occupational health hazards that induce moral distress among healthcare professionals (including physicians, nurses, and midwives). Traditionally framed as clinical ethics issues, moral distress emerges as a population-level public health concern when regulatory barriers systematically conflict with clinical judgment. Drawing on empirical evidence from abortion restrictions and European contexts (Italy, France, Spain), the case highlights psychological harms, burnout, and systemic consequences like defensive medicine and workforce emigration. Key normative questions address occupational risk classification, stress assessment tools, prospective legislative impact evaluations, occupational medicine roles, professional associations' advocacy, and institutional obligations balancing conscientious objection with service provision. The analysis reframes moral distress through a public health ethics lens, advocating expanded risk frameworks, organizational support, and policy interventions to protect healthcare workers while advancing population health goals.