Wt may seem surprising at first glance when I speak to you today as a military medical ethicist about the ethical perspectives of relationships in society, the Church and the Bundeswehr. In fact, I did not find it easy when the Catholic military chaplaincy approached me with the request to organise an officers' academy on issues of sexual diversity and the ethical structure of relationships. Even though I recently worked with Kerstin Schlögl-Flierl in Voices of the timeIn my article on relational sexual self-determination, published in issue 7/2023, other colleagues seemed to me at first glance to be more suitable to speak on relevant issues.
Is a medical ethicist allowed or even obliged to comment on such questions? This consideration acted as a key question in my preparation for this afternoon's lecture, which very quickly reminded me of some central texts in medical ethics that suggested an affirmative answer. As an example, I would like to refer to the Geneva Doctors' vow which places issues of sexual identity and orientation in the wider context of an anti-discrimination duty: "I will not allow considerations of age, illness or disability, faith, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social status or any other factor to come between my duties and my patient."
In the course of its history, this important medical ethics reference text has been updated time and again; with the inclusion of the aspects Gender (the English original speaks here more differentiatingly of gender) and sexual orientation (engl. sexual orientation), the issue of sexual diversity and its ethical organisation in terms of relationships had arrived in the medical ethics discourse at the latest. The central reference text on medical ethics issues in a military context, the World Medical Association's 2014 Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies, refers to this indirectly: "The primary task of health care personnel is to preserve human physical and mental health and to alleviate suffering. They shall provide the necessary care with humanity, while respecting the dignity of the person concerned, with no discrimination of any kind, whether in times of peace or of armed conflict or other emergencies."
The text also points out the relevance of other legal and ethical requirements: "Health care personnel shall at all times act in accordance with relevant international and national law, ethical principles of health care and their conscience." This general formulation naturally includes the corresponding requirements on gender and relationships, as set out, for example, in the United Nations Universal Declaration of Human Rightsthe Charter of Fundamental Rights of the European Union or also in the Basic Law of the Federal Republic of Germany to name just a few texts.
The fact that issues of sexual diversity and the ethical organisation of relationships also play an important role in the everyday life of the Bundeswehr can be seen, for example, in the fact that since 2019 there has been a separate Guidelines for dealing with transgender people exists. There has also been a Guide for the military medical service for gender reassignment medical measures for transsexualism. In addition, the medical service has had its own contact point for transgender issues for a few weeks now. And I am very pleased that the transgender officer, Chief of Staff Claudia Schalling, has come to Munich today! In addition to the important posts of Equal Opportunities Officer, diversity in the day-to-day work of the Bundeswehr Medical Service is particularly visible here. I am sure that in addition to general service issues, the post holder will also be dealing with specific medical service issues.
It is certainly no coincidence that the Catholic military chaplaincy is also addressing this important topic. Just a few years ago, it would have been rather difficult to organise an event on issues of sexual diversity and its significance in terms of relational ethics in a setting such as the one we have today. Fortunately, times are changing, even if it must be noted that the underlying ecclesial development process was not the expression of a sovereign official church decision, but rather became unavoidable in the wake of the abuse scandal and the findings of the MHG study in Germany.
The measures taken as part of the reform process Synodal way The questions addressed by the Church in Germany were largely in response to the fact that the traditional sexual morality of the Church had not only proved to be contradictory to the findings of modern natural and human sciences, but also incompatible in parts. In addition, the aim was to find ways to counter the Catholic Church's loss of credibility, particularly in the area of sexual morality.
In my opinion, the fact that we are trying to approach this topic this afternoon as part of an officers' academy is a small but important contribution when it comes to generating a general mindfulness for dealing with this in the service. I can only make a superficial attempt at orientation in my keynote speech, but hopefully it will inspire further thought.
After these introductory words, I would first like to look with you at some key terms that play an important role in the relevant discourses (Ethical dimensions of relationships). I will then turn to the social and military perspective (Social perspective/Military perspective), before we take a closer look at the ecclesiastical perspective (Church perspective). With regard to an appreciative diversity of human sexuality and its ethical organisation in terms of relationships, the reform process of the Synodal Path has provided important impulses that I find highly noteworthy for the debate in society as a whole. I would like to present to you some of the central views that have emerged from this (Living in successful relationships - impulses from the texts of the Synodal Path). Finally, I will summarise the key points for you once again.
Ethical dimensions of relationships
Human beings do not live alone. From the very beginning of our existence, we humans are relational beings; dependent on closeness to others, which we have to develop throughout our lives. Seen in this way, we could describe life as a relationship project. Relationships are part of us and our lives. To a large extent, they characterise what anthropology, i.e. the study of human beings, calls conditio humana i.e. the characteristic constitution without which a life that deserves to be called "human" is not possible.
It is indeed an exciting endeavour to take a look at one's own or other people's lives from this perspective. I am convinced that such biographical work with the aim of analysing life as a relational life (i.e. as a life in relationship) would provide a variety of insights. The relationships that characterise us and our lives could be examined from a variety of perspectives: Medical, psychological, sociological, philosophical, theological, anthropological, ethical - to name but a few.
The experience of relationships in our own family of origin is certainly formative for us and our lives, whereby this can already be described as a network of relationships. There is, for example, my relationship with my parents and siblings, but also the relationship between my parents, which allows us to understand our own existence as a relational existence from the very beginning. But relationships with friends, classmates, teachers, colleagues and comrades also have a character that shapes and sometimes challenges us and our understanding of relationships. Relationships with partners, which find their very own expression not least in their sexual dimension, are also of particular importance. In the case of possible parenthood, the special relationship with one's own or adopted children opens up a further deepened experience of relationship, which closes the circle outlined here.
Parallel to a broadening of traditional ideas of partnership, marriage and family in recent decades, there has been a more differentiated view of the gender dimension of people and the relationships that give expression to this. In addition to marriage as a traditional union between a man and a woman, other relationship and family constellations have emerged, for example in the case of same-sex partners. In my view, the latter (and I would like to emphasise this at this point) are by no means a threat to traditional marriage and the family, but rather an enriching and ethically worthy entity for our society as a whole.
In order to see a little more clearly here and to acquire the necessary tools to participate in social discourse, I would like to briefly and by no means comprehensively discuss some key terms with you below. Critics of the current broadening of the understanding of sexual diversity and its relationship ethics often lack a terminologically sound approach. Under the heading of "gender criticism", a kind of culture war is often conjured up in a frightening ignorance of philosophical theories and their terminology. The classical understanding of sexuality, marriage and family is put in a defensive position, accusing the other side of undermining and destroying traditional values and norms. The fact that considerations of the gender issue could ultimately lead not so much to the weakening as to the strengthening of a morally responsible approach to questions of sexuality, lived relationships, parenthood and family is usually not considered.
With the concept of gender, we are already in the middle of the essential terminological work. The term "gender" originally comes from social philosophy and refers to a person's social gender, which can be distinguished from their biological gender (sex(us)). Various studies, for example in philosophy, sociology and psychology in the second half of the 20th century and at the beginning of the 21st century, underpinned the realisation that much of what we call male or female is less an expression of a biological fact than a socially constructed one.
The theoretical approaches advocated in this context are diverse. A self-contained and generally shared theory on the gender issue does not yet exist. Gender" is therefore a term that is used heterogeneously, so that it seems more appropriate to speak of different gender theories rather than a self-contained gender theory. Without being able to go into the various gender theory approaches here and now, it can nevertheless be said that an honest reflection on the phenomenon of "gender" cannot avoid taking different dimensions into account. The questions of gender identity (e.g. manhood and womanhood) are posed anew here, not least in anthropological and ethical terms, which has led to fierce counter-reactions from critics of gender theory approaches. This also applies to the Roman Catholic magisterium, for example, which speaks of "gender ideology" in this context with little differentiation and inappropriately.
The gender discourse has enabled an in-depth discussion of further phenomena of gender identity that are not new, but have now become socially visible and could be verbalised by providing an appropriate terminology. Paradigmatically, I would like to refer to transsexuality, which impressively demonstrates that birth gender and social gender do not necessarily have to coincide. Even if this is the case for the majority of the population, it cannot automatically be assumed that they are congruent. While in the case of congruence of birth gender and social gender we speak of cis people, trans people are characterised by the fact that they feel they belong to a different gender than the one they were assigned at birth. A trans man is therefore a person who is female at birth and self-identifies as a man. Conversely, a trans woman is a person of the same sex at birth who identifies as a woman.
The distinction between cisgender and transgender already shows that a rigid binary view that classifies people as either men or women can (or rather, must) be critically scrutinised. By doing so, gender theoretical approaches also invite us to critically question other binaries that characterise our everyday understanding of gender and relationships. In other words: Gender theory approaches break down outdated binary ways of thinking. Just think of the stereotypical ideas of earlier times: Here, men were usually portrayed as strong, protective, dominant, active, rational, controlled and independent, while women were not infrequently characterised as weak, protected, submissive, passive, irrational, emotional and dependent. The term "non-binary" ( non-binary) characterises the rejection of a rigorous dichotomy and serves as a self-designation for people who do not identify themselves as men or women in the sense of an "either - or" decision.
This brief and by no means exhaustive examination of different gender identities alone shows the urgency with which gender theory discourse must be conducted. This is by no means dispensable philosophical speculation, but a necessary discussion that takes account of the mostly painful reality of people's lives and attempts to do justice to the phenomenon of gender identity in its entirety. In this context, I would like to refer only in passing to the documentation Trans - I got life by Doris Metz and Imogen Kimmel from 2021, a film documentary on the culture channel arte, which provides in-depth insights into the topic.
The phenomenon of intersexuality, which refers to people who are born with mixed-gender bodies, should be distinguished from transsexuality, i.e. they have congenital variants of physical sexual characteristics that cannot be clearly categorised as only male or only female. This can affect, for example, the sexual organs, hormone production or chromosome set, figure, hair distribution or muscle mass. People who describe themselves as intersex have a wide range of physical sexual characteristics. It is important to note in this context that the question of sexual identity remains unaffected by this, i.e. they can identify as cis, trans, non-binary or inter.
The question of gender or sexual orientation must be distinguished from the question of gender identity. In short, the term "sexual orientation" refers to the gender that a person desires. Here too, in addition to the heterosexual orientation that dominates the population in terms of numbers, there are norm variants of sexual orientation that relate to the same sex (homosexual) or different sexes (bisexual/pansexual) or no sex (asexual). Here too, the phenomenon of norm variance in sexual orientation is not new, but has become visible and verbalised in the course of the liberalisation of Western societies.
The terms used to describe sexual identity and orientation can be summarised in the acronym LGBTQIA+. This refers to the English terms "lesbian", "gay", "bisexual", "transgender", "intersexual" and "asexual". The letter Q refers to the term "queer", which is not easy to define. On the one hand, it can serve as an umbrella term for the other terms to which the acronym LGBTQIA+ on the other hand, it points beyond them. The same applies to the plus sign at the end. It refers to the fact that there are forms of sexual identity and orientation that, on the one hand, elude a rigid binary identity of man and woman and, on the other hand, do not correspond to a heteronormative orientation.
Social perspectives
If I take a look at the social, ecclesiastical and military perspectives with you in the following, then this can only be done in the form of highlights. Basically, it can be said that the three spheres are mutually dependent on each other and are not always free of tensions. Today, the relationship between society and the church is proving to be particularly challenging. While, for example, the Bundeswehr has adopted and implemented the various German laws that have promoted equality and self-determination over the last 30 years, the Catholic Church has struggled with this to this day.
It would be an exciting endeavour to take a look at the history of German society from the perspective of relationship ethics. Unfortunately, we can only do this in outline today, but even a superficial examination shows that we are dealing with a development that could not have taken place without the knowledge gained in the fields of sociology, psychology, philosophy, anthropology and ethics. In the field of philosophy (and theology), feminist and subsequently gender-theoretical approaches have certainly played a decisive role in initiating and shaping the social reorganisation processes that we have been experiencing since the late 1960s in particular and which continue to this day.
In this context, I would like to remind you of the profound changes that took place in the course of the women's rights movement. A patriarchal understanding of the family first had to be broken down in order to create space for new forms of family coexistence. The relationship between parents, but also the parent-child relationship, has undergone far-reaching changes in recent decades. Changing social perceptions, which were usually intensively flanked by discourses in the humanities, were reflected in a series of legislative changes, for example with regard to family, filiation and maintenance law in the German Civil Code. It was by no means the case that these remained without opposition in certain parts of society. Regulations were fought over in sometimes heated debates.
The significant changes that have taken place with regard to the rights of homosexuals should also be mentioned here. The path taken from the adoption of Section 175 of the German Criminal Code from the National Socialist era to its final cancellation in 1994 is an exciting piece of German legal history. The rehabilitation of those convicted on the basis of the former Section 175 StGB in 2017 was certainly a milestone in further developments.
The gradual legal equality of same-sex partnerships, which culminated in the opening of marriage for all in 2017, should also be recognised here in a special way. Not least from a medical point of view, the law passed in 2020 banning conversion therapies plays an important role.
important significance.
When we look at transgender rights, we see a legal history that reflects the struggle of the people concerned for recognition and equal rights. In fact, there have always been people whose sexual identity was at odds with the gender ascribed to them at birth. In the Federal Republic of Germany, the Transsexuals Act passed in 1980 made it possible for the first time to lead a life in accordance with one's own trans identity (with a change of birth certificate and civil status).
In its original version, the law stipulated that the persons concerned could either opt for a change of name (minor solution) or a change of civil status (major solution). While a change of name could be effected by submitting two expert opinions to the court confirming the trans identity, a change of civil status required gender reassignment surgery (including sterilisation). Parenthood was not possible for trans people.
Over time, several judgements by the Federal Constitutional Court have led to parts of the Transsexuals Act being repealed as unconstitutional. For example, the obligation to undergo gender reassignment surgery and sterilisation was dropped in 2011. The option to marry and become parents was also subsequently granted. The draft Self-Determination Act, which was passed by the Federal Cabinet at the end of August 2023, is a draft law that replaces the Transsexuals Act and provides for a significantly simplified option to change one's name or marital status.
Military perspectives
In line with German legislation, there have also been drastic changes in the Bundeswehr. Whereas in the 1990s, for example, homosexuality was grounds for ineligibility for military service, today gay and lesbian soldiers, reservists and civilian employees also perform their service. They are comrades and employees with equal rights. The same applies to people with trans or inter-identity. The fact that the realisation of the claim to equality is still a challenge not only in civil society, but also in the Bundeswehr, is evident in the day-to-day service of the comrades and employees concerned.
Both the necessity of the above-mentioned Guidelines for dealing with transgender people or the newly created contact point for transgender issues illustrate this. On the topic Diversity management There is certainly a lot to be said about the issue of the German Armed Forces and I hope that we will hear a lot more about this in the subsequent panel discussion. I would also like to draw your attention to the recently published General Regulations (AR) Dealing with sexuality and sexual misconduct in the business area of the Federal Ministry of Defence (GB BMVg).
Church perspectives
From an ecclesiastical perspective, the Synodal Path, which was
The forum was established following the revelation of the abuse scandal and the MHG study and represents a decisive and groundbreaking turning point. It was a discussion forum with the aim of organising a structured debate within the Roman Catholic Church in Germany. It centred on four main topics, including the question of a life in successful relationships.
Based on the realisation that the sexual morals of the Catholic Church no longer provided guidance for the majority of baptised people, key questions of sexuality and partnership were addressed based on modern findings from theology and human sciences. This included, for example, the highly relevant social issues of same-sex partnerships and transsexuality, in which an attempt was made to connect with the reality of life today.
Very few people were surprised that this development would not be accepted without resistance from traditionally orientated circles. The central (basic) text developed in the course of the Synodal Path Living in successful relationships - basic principles of a renewed sexual ethicwhich I will discuss in more detail below, was approved by an overwhelming majority of the synod members, but ultimately failed due to the blocking minority of the German bishops (82.8 % of all synod members voted in favour of the text, with 33 of the bishops voting in favour (61.1 %) and 21 voting against (38.9 %) with 3 abstentions). The fact that the required majority was not achieved among the bishops meant that the text was not adopted.
Despite this disappointing result for many, it can be said that the questions raised during the Synodal Path can no longer be ignored. The latter would only be possible at the cost of a total misjudgement of the reality of life today. The proposals for a renewed sexual ethics made by the synod members set standards that any further engagement with the topic (whether in favour or against) will have to deal with in a scientifically critical manner. And it will be exciting to see to what extent the reform proposals made during the Synodal Path can be successfully incorporated into the Synod currently taking place in Rome.
Living in successful relationships - impulses from the texts of the Synodal Path
Without being able to present the document to you in its entirety, I would nevertheless like to draw your attention to some statements that are highly noteworthy. It is an important document insofar as it attempts to bring church sexual morality into line with the reality of people's lives today and the human scientific and ethical discourse that accompanies it. Nothing less than a fundamental reorientation of church positions is proposed.
The text presents concrete proposals for a reform of the church's sexual morality in ten so-called basic principles. Sexuality is understood as a gift and a task to shape (basic line 1), which is to be honoured as a sexual identity in its diversity over the entire lifespan of a person (basic line 2). Sexuality must be taken seriously in its multidimensionality, both as a physical and as a spiritual reality (Basic Principle 3). It proves to be fruitful not only through the procreation of offspring in Christian marriage.
Openness to new life is also expressed in the adoption and upbringing of children, for example by same-sex couples or single people (basic line 4). In this context, there is a re-evaluation of homosexuality and the question of how it can be lived responsibly as a Christian (basic line 5). Lived sexuality, which is committed to human dignity, is understood as a life-giving force that also has a spiritual dimension (basic line 6). This applies to interpersonal relationships as well as in the relationship between people and themselves (basic line 7).
Central importance is of course attached to sacramental marriage as a covenant of life practised in Christianity. Same-sex partnerships that have a binding (i.e. permanent) character are placed alongside it. In addition, partnerships that are entered into after the breakdown of a marriage are also in the focus of the synod. Even if only marriage can have a sacramental character, all three forms may consider themselves to be under the blessing of God granted by the Church (Basic Principle 8). The conscientious shaping of one's own sexuality is relevant for a life in the midst of the community of believers (basic line 9); it is an expression of freedom and finds its realisation in the risk of love (basic line 10).
From the point of view of traditional Catholic teaching, these 10 basic principles represent an extraordinary further development. The associated re-evaluation of human sexuality can be seen not least in the statements on gender identity and orientation, which I would like to discuss in more detail in conclusion. A positive appreciation of the diversity of human sexuality and its ethical organisation in terms of relationships cannot avoid keeping both aspects in view.
Sexuality is understood here as an integral part of a person's personal identity and the reality of their life. It always remains tied back to the dignity of the persons concerned, as stated in Basic Principle 1: "Dignity includes the right to sexual self-determination: supporting it and strengthening it in its commitment to the morally good is just as much a part of the basic mission of the Church as respect for sexual identity - regardless of age or sexual orientation."
This idea is taken up and developed further in baseline 2: "Every personal identity is in development. Sexuality also develops over the course of a lifetime. An indispensable principle for shaping sexuality is mutual, loving respect for the dignity of the other person and the dignity of oneself. Such respect must also be shown to every form of gender identity and sexual orientation. Both sexual orientation and gender identity are the result of a personal growth process."
The growth process referred to here is understood as a biopsychosocial one, i.e. influencing factors of various origins are regarded as significant: "Identity development is not a purely internal, automatic process. It is also not only influenced by external factors, but can also be consciously shaped by each person. Of course, identity cannot be moulded at will. It is always shaped within the physical, biopsychological and sociocultural prefigurations within which each person can and must lead their life."
For the authors of the paper, this results in an absolute ban on discrimination. For example, in the theoretical foundation of baseline 2, it states with regard to sexual orientation: "The recognition of the equal value and legitimacy of non-heterosexual orientations, their practices and relationships, and in this context the elimination of discrimination based on sexual orientation, is urgently required."
Demands for medically unindicated manipulation, such as conversion therapies, cannot be justified in any way either. This point is taken up in Principle 5: "So-called conversion treatments and similar offers aimed at the disintegration of personal identity in relation to gender identity or sexual orientation and thus jeopardising the health and faith of homosexual and transgender people must be strictly rejected and prohibited."
The ban on conversion therapies is an example that impressively demonstrates the proximity of questions of sexual and relational ethics to medical ethics. With regard to principle-based medical ethics, it can be stated that this is a serious violation of the principles of autonomy, non-harm, beneficence and justice.
Even these brief remarks reveal an attitude on the part of the Synod members that takes account of the diversity of human life, without which sexual and relational ethics can no longer be credibly conceptualised in the 21st century. The aspects addressed here are highly relevant for all those who endeavour today to responsibly shape the relationships that characterise our lives. They prove to be worthy of consideration for believers and non-believers alike when it comes to living a life of freedom and self-determination.
Summary and outlook
Starting with the question of the medical-ethical relevance of considerations of relational ethics, we first undertook a terminological approach to the topic and looked at some key terms. Based on this, social, military and ecclesiastical developments were analysed. Finally, I presented important impulses from the Synodal Path on the topic of lived sexuality and its ethical organisation in terms of relationships.
The diversity of human sexuality and its forms of expression became clear. Responsible relationship ethics will always have to take this diversity into account. This applies to each and every one of us, regardless of which identity or orientation we have been given in our personal lives to shape in a self-determined way. In the sense of the relationship structure outlined at the beginning of my presentation, this is a task to be tackled both individually and collectively. It finds its concretisation in social, military and ecclesiastical contexts. Even if these three areas challenge us to varying degrees, in the end the following applies to each of them: Diversity will set you free!
