The Abandonment of Moral Values in a Military Context: Moral Injury as a Distinctive Focus of Ethical Reflection in the German Armed Forces

Introduction

The discussion of moral injury in psychiatry and psychology has once again brought ethics to the fore as a key military competence – a side effect that proves significant, not least against the backdrop of the challenges of national and alliance defense. This is particularly true in light of the alarming challenges currently confronting international humanitarian law and the Geneva Conventions. In times when compliance with the associated legal and moral obligations is openly weighed against considerations of one’s own advantage, there is an urgent need to return to individual and collectively shared ethical and moral markers that, even in periods of military conflict, allow a minimum standard of humanity to prevail.

That abandoning ethical and moral standards entails significant consequences becomes evident, not least, in the observations that have been discussed since the 1990s under the heading of “moral injury”. Moral injury is a phenomenon situated at the intersection of psychiatry and ethics, with moral concerns taking on direct clinical relevance. Discussing these moral issues requires a minimum level of ethical education on the part of both patient and therapist – education that enables them to recognize moral conflicts as such, articulate them and, where appropriate, address them in a clinical setting. What applies to diagnosis, therapy and rehabilitation also proves to be importantly significant for the possible prevention of moral injury.

The fact that moral injury requires interdisciplinary analysis means that not only psychiatry and psychology, but especially ethics as well, must be able to give a coherent account of the phenomenon. Morality, understood as a term for individual or shared values, principles and norms, is first and foremost an object of ethical reflection. Given the renewed attention to its subject matter, ethics will therefore need to play a central role in the discussion of moral injury. Ethical education must impart a capacity that enables individuals to recognize moral injury for what it is: a potential threat to the person that, in order to be addressed appropriately, requires thorough prior engagement.

Soldiers’ difficulty articulating concepts such as ethics and morality – repeatedly observed in the context of ethical training – is often accompanied by a lack of awareness of their own values, and of the moral convictions and expectations that arise from them. Ethical education intended to provide preventive, diagnostic and therapeutic support in addressing moral injury will have to begin here: What does ethics mean? What does morality mean? What role do ethics and morality play for human beings as moral agents? Why are moral convictions and expectations particularly vulnerable in a military context? How can moral injury be illuminated from an ethical perspective?

Moral injury as a phenomenon at the intersection of psychiatry and ethics       

The phenomenon of moral injury is not new in the history of ethics, but its psychiatric and psychological significance was first articulated under that description by Jonathan Shay in his 1994 work Achilles in Vietnam: Combat Trauma and the Undoing of Character^[1] in the context of war-related post-traumatic disorders, and was taken up by Brett Litz et al. in their ground-breaking 2009 article “Moral injury and Moral Repair in War Veterans”^[2]. Both publications examine moral injury not as an ethical phenomenon but as a psychiatric one – one that subsequently received sustained attention from a large number of different authors.^[3]

From both a medical and ethical perspective, the distinctive feature of moral injury is that it is not an issue of medical ethics that merely accompanies clinical medicine in research, diagnosis and therapy. Rather, it is a phenomenon with direct clinical relevance: compromised morality gives rise to moral injury – that is, an ethical phenomenon has a psychopathological consequence. This poses a particular challenge for both ethics and medicine. Moral injury proves to be clinically relevant, meaning that the question of compliance or non-compliance with ethical principles is central to a psychiatric disorder that requires treatment. In this context, ethics and morality are not only important for meta-clinical reflection but are also central to clinical interaction – an interaction that demands a considerable degree of ethical competence from both patients and their therapists.

Ethics, morality and profession

Ethics and morality are ubiquitous terms in the media and are likewise used in a wide range of contexts within the German armed forces. Nevertheless, it remains necessary to clarify what is actually meant by these terms. Their frequent synonymous use must be critically examined, not least with a view to developing a more nuanced understanding of the phenomenon of moral injury.

Ethics refers to the critical, systematic reflection on moral actions and on the values, principles and norms that underlie those actions. The academic discipline of ethics can be further subdivided. In addition to foundational ethics, which addresses fundamental questions, a variety of area-specific branches of ethics can be identified. In the context of the German armed forces, paradigmatic instances of applied ethics include military ethics, military medical ethics, cyber ethics and peace ethics.^[4]

Ethics is part of the humanities, i.e., the disciplines that study human beings and their characteristics. This includes the ability to distinguish between good and evil and to act accordingly; it can be described in terms of morality and ethical life. Ethical competence training invites reflection on the meaning of morality and ethical life. It is closely tied to the insight that human beings are endowed with moral and ethical capacities and, accordingly, can and must understand themselves as such.

Our lives are marked by countless actions that we carry out each day. We do not always consider whether an action is right or wrong. When this question becomes relevant in deciding on a course of action, we speak of a moral action in a narrower sense, i.e., an action that is a conscious expression of our moral values, principles and norms.   

The discourse on moral values, principles and norms is an expression of our moral orientation. These moral commitments play an important role in deciding on a course of action. For example, life can be identified as an important value, from which the principle of protecting life can be derived. This principle, in turn, is reflected in a series of normative standards, such as “Save drowning people!” or “Feed the starving!”. Human beings hold a multitude of shared as well as individual values, principles and norms. They are taught and learned in various contexts, such as in the family, at school, and also within the German armed forces. The sum of an individual’s or a community’s values, principles and norms can be described as their morality.

Moral competence is required to assess a situation and act accordingly. Another term for this is moral fitness. The analogy to the concept of fitness in sport is deliberate. Simply deciding to run a marathon once in your life does not, by itself, make you a marathon runner. It takes extensive, often strenuous preparation before you can do it. You might read a book on the subject or talk to others who have already done it. It’s probably worth thinking about your nutrition. But above all, you need to start training. The decision to be a moral person is much the same. For example, the mere realization that it is desirable to be a just person does not make one just. Here, too, it is important to begin both theoretical and practical training.

This is all the more important given that many situations have no straightforward morally right or wrong solution. The resulting moral dilemmas are characterized by two or more moral values, principles or norms of equal importance coming into conflict. Decisions in such cases always have both positive and negative consequences, which can be very stressful and sometimes traumatic. In a military context, a moral dilemma often takes the form of a dual loyalty conflict. Such a conflict can arise from the dual medical and military roles involved. Here, the values, principles and norms of the medical profession collide with those of the military. This can occur, for example, when operational constraints prevent medical care from being provided to the civilian population because it must be subordinated to military objectives (military necessity vs medical urgency).

Ethical challenges in everyday military life

This example shows how closely decisions about how to act are tied to specific role expectations. The question “What kind of soldiers do we want to be?” is inextricably linked to a set of other questions that arise from the roles people hold in life. We might also ask: “What kind of parents do we want to be?”, “What kind of doctors?”, or “What kind of citizens?”. These questions lead to the broader question: “What kind of people do we want to be?”. And the answer to this depends entirely on engaging with the ethical and moral challenges of everyday military and private life. The two areas are inextricably linked. Ethical decisions made on the job affect a person’s private life, and the reverse is also true. The various roles that shape a person can only be realized in an integrated way – never in isolation, and certainly not in opposition to one another. This is a task that should not be underestimated.

The various roles that shape a person can only be realized in an integrated way – never in isolation, and certainly not in opposition to one another

Ethics therefore plays an important role in all areas of military competence. Adapting the US Army’s Comprehensive Soldier Fitness model, a three-part model can be formulated that works with three areas of military competence.^[5] In addition to physical and mental fitness, this model also identifies moral fitness. 

Physical, psychological and moral injury 

This seems necessary, not least given the significance of possible moral trauma. Alongside physical and psychological injury, moral injury is becoming increasingly important and is now gaining wider public attention through interdisciplinary research on the subject. Moral injury arises in the context of post-traumatic stress disorders. The World Health Organization’s International Classification of Diseases (ICD-11) states the following about post-traumatic stress disorders: “Affected individuals were exposed to a brief or prolonged event or occurrence of exceptional threat or catastrophic magnitude”. A closer look at the causes allows us to distinguish between accidental and interpersonal trauma. While accidental trauma is primarily caused by natural or technological disasters, interpersonal trauma results from human action (man-made trauma).^[6] Examples include criminal violence, sexual abuse, armed robbery, domestic violence, war, combat, torture, hostage-taking and imprisonment in concentration camps. Interpersonal traumas all show that, unlike accidental traumas, they raise serious moral questions. This difference is also reflected in the traditional philosophical distinction between the forms of evil that human beings can suffer: natural disasters are described as malum physicum, while man-made or moral evil is described as malum morale. It is noteworthy that discussions of both interpersonal trauma and malum morale have always indirectly referred to what we now describe as moral injury.

Even though moral injury is the recent name for a clinical condition that can occur in the context of post-traumatic stress disorder, there has always been moral injury. Interpersonal trauma (or suffering caused by moral evil) and the deep conflicts of values, principles and norms it produces have long posed a particular challenge and have been expressed in many ways, not least in art and literature.

Based on current knowledge and research, moral injury can be defined as a profound moral upheaval arising in the context of psychologically traumatic events in which one’s own, or another person’s, actions or inactions conflict with the values, principles and norms of those affected and can no longer be reconciled with them. Three aspects are particularly noteworthy here: it involves a profound moral shock in the context of psychologically traumatic events; it concerns one’s own or other people’s actions or inactions; and these actions or inactions contradict the values, principles and norms of those affected. Individuals can thus suffer moral harm through their own actions or inaction, for example, by being forced to act or being forced not to act. Or they may suffer moral harm as a result of someone else’s actions or inaction: as victims, when the action or inaction is directed against them, or as witnesses, when they observe it and are unable to intervene.  

The moral fitness model

For ethics, moral injury is of considerable importance in several respects. It is clear that ethical and moral questions have direct clinical relevance for the diagnosis, treatment, rehabilitation and prevention of moral injury. It should be noted that recognizing, identifying and discussing moral conflicts requires a considerable degree of ethical competence within the therapeutic dialog, on the part of both therapist and patient.

And thus the phenomenon of moral injury can be situated within the broader context of ethical training and ethical competence. The literature on moral injury generally highlights different aspects, yet it does not bring them together to provide an overall picture. The Moral-Fitness-Model on Coping with Moral Harm places the phenomenon of moral injury within the broader context of ethical training and the development of ethical competence (see fig. 1).

DOI: 10.48701/opus4-835