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Moral Decisions and Military Mental Health

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Human Factors and Medicine

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ethics training, leadership, Moral decisions, moral injury, psychological distress


Military operations often involve difficult decisions that can affect the well-being of the decision-makers, their subordinates and peers, their adversaries and civilians impacted by the conflict. Although noted as a consequence of earlier conflicts, post-Vietnam saw an increased focus on the psychological consequences of war, including real or perceived ethical lapses and violations. Although they have been primarily associated with war, these decisions exist throughout the full-spectrum of military operations (e.g. peacekeeping, peacemaking, humanitarian, as well as combat). One of the inherent difficulties stems from the fact that these decisions can require the service member to choose between mission success, civilian safety, force protection and unit loyalty. These decisions have fundamental moral implications and impact and therefore in itself create psychological distress. Military service members also have a professional responsibility to behave in accordance with laws, values and ethics. Seminal research from the United States has demonstrated that the underlying presence of psychological distress may negatively influence soldiers’ attitudes towards following the laws of armed conflict and rules of engagement. This was found to be associated with behaviors that violated the military code of conduct, laws of armed conflict and other unethical behaviors. In these lecture series will be highlight the bidirectional relationship between ethical lapses and psychological distress including mental illness, that is, not only can bad decision have mental health consequences, but those that are suffering from psychological illness or are highly symptomatic are more prone to ethical lapses in attitudes and/or misconduct.


The objective of this RTG is to organize and carry out a RTO Lecture series (RLS) on the impact of moral decisions in military operations and their relationship to mental health outcomes. This is to better disseminate the results of RTG-179 among operational communities in NATO and Partner nations; present the empirical evidence concerning potential links between moral challenges and mental health outcomes for deployed military personnel; present operational ethics and mental health training programs of contributing NATO countries; translate findings concerning issues related to the potential links between moral decision making and the psychological well-being of military personnel in modern military operations. The lectures will also recommend good practices in coping with moral dilemmas and develop awareness of tragic dilemmas; advise on the development, and the creation and implementation of operational ethics training/education to promote better moral decision making, attitudes and behavior during deployments and to prevent and limit mental health problems, and formulate recommendations for pre, during and post-deployment care- and education programs.


The RLS will cover the following key topics and dimensions: the relationship between the confrontating moral dilemmas and mental health problems by generation of first-hand accounts of moral and ethical dilemmas that military personnel faced in (NATO-) operations. Driving questions are: o Is there a relation between the confrontation of a moral challenge or dilemma and mental health problems among military personnel? Is the relationship bidirectional? o What is the impact of ‘tragic dilemmas’ on military personnel, both positive and negative? o What types of dilemmas can be distinguished? o What are the consequences for educational and training purposes and programs? o What is the best way to train for ‘moral competence’? o Is moral competence related to the personality of soldiers and his or her development? Does this count for the armed forces as a whole, or for specific groups? o Are there cultural differences between countries in dealing with moral and ethical decision making, how do they train their military personnel and what are the consequences for the NATO operations? A RTO Lecture series (RLS) will be organized and conducted; a description of existing clinical practices for all participating NATO countries; a summary of current research projects and predicted target dates for completion; identification of existing gaps in knowledge; and principles for best practices. The specific deliverables will include the development of a lecture series with slides and notes which will be conducted at two European locations and one North American location by speakers. The duration of the Technical Team will be for a period of two years.

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