|Operational Ethics: Preparation and Interventions for the Future Security Environment|
|Human Factors and Medicine|
mental health and wellbeing, moral challenges, Operational ethics, operational preparation and intervention
NATO HFM-RTG-179 and HFM-RLS-284 ‘Moral Decisions and Military Mental Health’1 recognized that “military operations often involve difficult decisions that can affect the well-being of the decision-makers, their subordinates and peers, their adversaries and the civilians impacted by the conflict. At times these decisions require the service member to choose between mission success, civilian safety, force protection and unit loyalty. Hence, these decisions have fundamental moral implications that can create psychological distress and moral injury. Complicating matters, these decisions are often made under a range of powerful stressors including danger and risk, time pressure, incomplete or ambiguous information, sleep deprivation, and intense emotions. Finally, as recent missions have made clear, “a single bad decision can erode local, national, international and host nation support thereby derailing the strategic mission and putting troops at risk”. HFM 179 and 284 also reviewed and summarized the evidence concerning “the bi-directional nature of ethical lapses and mental health and well-being: such lapses can cause psychological distress but types of psychological distress (e.g., the anger, grief associated with seeing comrades killed) can increase the likelihood of unethical attitudes and behaviors.”In their final report the members of HFM-179 made a number of recommendations concerning ways to better address ethical challenges in military operations in the future including: “(1) a move away from an exclusive focus on the relationship of ethical violations and PTSD to a wider examination of sub-clinical mental health problems, Combat Operational Stress Reactions (COSR), anger/aggression and specific combat experiences; (2) a deeper understanding of guilt and shame as these seem to be drivers for a range of mental health problems including concepts such as moral injury that need to be recognized. Treating PTSD with accompanying guilt, shame and grief may be more complicated and require exploration and more time than current ‘standard’ evidence-based PTSD treatment regimens. (3) the incorporation of the findings of the relationship between COSR and ethical violations into military leader and clinician education and training; (4) that health providers be made aware of the relationship between ethical decisions and mental health problems and (5) an increased integration of scenario-based ethics training as part of military and mental health education, prior to operations. The purpose of this ET is to further explore and to expand on these recommendations in order to develop a follow-on RTG in this area.
This ET will produce the following outcomes:
(1) Technical Activity proposal (TAP) for an RTG on the topic of novel preparation and intervention strategies for operational ethics in the FSE.
(2) ToR for the RTG; and
(3) Program of work including deliverables and timelines, for the RTG
1. Characterize the nature of the ethical challenges in the future security environment; including identifying new mission characteristics that can increase ethical challenges in operations (e.g., joint targeting, whole of government operations, cultural stress);
2.Further characterize the relationship between operational stressors and moral lapses and mental health;
3.A wider examination of the relationship between ethical challenges, specific combat experiences and sub-clinical mental health problems, Combat Operational Stress Reactions (COSR), anger/aggression;
4.Understanding the phenomenology of guilt and shame as these seem to be drivers for a range of mental health problems including concepts such as moral injury;
5.Survey new ways to determine the impact of ethical challenges on soldier well-being (e.g., neurological and physical considerations using techniques like fMRI, and heart rate variability);
6.Survey novel approaches (e.g., ethical scenarios integrated into high intensity military training and refresher training in theatre;) and technologies (e.g., virtual reality) for education and training to better prepare military personnel, leaders and health care providers to be effective and resilient in the face of ethical challenges and provide novel treatments for moral distress, including moral injury resulting from such operational challenges.