The Limbic Brain, Moral Distress and Ethical Decision-Making in Nursing Practice.

Nursing practice unfolds at the intersection of the body's regulatory systems and the emotional and social realities of care. The paper examines how the limbic brain mediates between the body's internal environment, interoception, allostatic regulation and autonomic arousal, and the external social world shaped by hierarchy, norms, power and institutional pressures. It also explores how this mediating role influences moral perception and clinical decision-making. Drawing on Damasio's somatic marker hypothesis and contemporary work on affective neuroscience, I analyse the strengths and limitations of the claim that emotion is not opposed to reason but an essential element of it. I integrate the complementary neurocognitive perspectives of predictive processing, interoceptive inference and the neural architecture of moral emotion, with nursing ethics literature on moral distress, to show how affective states can both guide and distort clinical judgement, particularly under chronic threat. To ground this analysis, I draw on Foucault's genealogy of discipline and visibility, Morgan's account of modern suffering and Arnault's exploration of redemption. Emotions such as guilt, shame, compassion, elevation and hope are examined as morally significant emotions that can undermine or strengthen nurses' professional integrity. Evidence-informed strategies are proposed for nursing leaders to transform moral distress into moral resilience through relational governance, psychologically safe practices and ethical policy design. The paper concludes that ethical clinical decision-making is a whole-body, socially embedded achievement and that cultivating ethical climates requires attending not only to rules and resources but also to how organizations shape the affective and relational environments in which nurses think, feel and act.