Evidence map›Paper›PMID 42051597›Full record

ArticlePublic health ethics2026

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

Elpidio Maria Garzillo, Vincenzo Crispino, Maria Grazia Lourdes Monaco

Abstract readCase Reports
In one paragraph

Article in Public health ethics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Elpidio Maria GarzilloDepartment of Prevention, Abruzzo Local Health Authority, L'Aquila 67100, Italy.ORCID https://orcid.org/0000-0002-9468-2932
Vincenzo CrispinoSalerno Local Health Authority, Salerno 84121, Italy.
Maria Grazia Lourdes MonacoDepartment of Diagnostic and Public Health, University of Verona, Verona 37134, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Identifiers

PMID42051597
PMCPMC13112430

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.