Delirium in the Intensive Care Unit (ICU) is characterized as an acute neurocognitive syndrome and, according to clinical evidence summarized in the source, can affect up to 80% of patients who are mechanically ventilated. Standard biomedical definitions — for example, diagnostic criteria in the DSM-5 — frame delirium in terms of observable cognitive and attentional disturbances. The article argues that these biomedical metrics risk overlooking deeper experiential and existential consequences for patients, specifically an ontological rupture in the person’s lived sense of self.
The stated aim is to bring together clinical findings and phenomenological reflection to assess how delirium transforms patient identity and to clarify the ethical responsibilities that arise for the clinical team. The work seeks to move beyond strictly pathophysiological descriptions to consider how delirium affects narrative continuity, selfhood, and the moral standing of patients within care relationships.
The authors conducted an interdisciplinary conceptual analysis. They combined pathophysiological data and clinical meta-analyses with philosophical frameworks drawn from the phenomenology of perception, theories of narrative identity, and the ethics of vulnerability. This method is conceptual rather than empirical: it synthesizes existing clinical literature with philosophical tools to generate a normative and descriptive account of delirium’s effects on personhood.
From the phenomenological perspective developed in the article, delirium operates by suspending what is termed the "intentional arc". This suspension leads to a collapse of the lived world: patients lose the ordinary scaffolding of perception and meaning that binds past, present and future into a coherent self-narrative. The experience is marked by fragmented temporality — disrupted continuity of time and memory — and distorted otherness, where familiar persons and contexts are perceived as alien or threatening. These changes are presented as not merely symptomatic but as fundamental disruptions to the patient’s ontological standing.
The article highlights subphenotypes of delirium, notably hypoactive delirium, which may be particularly prone to being overlooked in clinical settings. Hypoactive presentations can produce what the authors describe as epistemic injustice: the patient’s testimony, experiences and expressions are silenced, minimized or discredited. This injustice has moral and clinical consequences, as failing to hear or value patients’ subjective reports limits opportunities for appropriate care and for reconstituting a coherent personal history.
Delirium’s sequelae are linked to Post‑Intensive Care Syndrome (PICS). The authors conceptualize PICS as a "biographical disruption" — a wound to selfhood that persists after the ICU episode. Rather than a set of discrete biomedical deficits alone, PICS is framed as a disturbance in the continuity of narrative identity: patients may experience lasting fragmentation of life stories, roles and self-understanding following critical illness and delirium.
Given these phenomenological findings, the article argues that clinical evaluation must extend beyond pathophysiology to include what it calls narrative competence: the capacity to listen for, elicit, and help reconstruct the patient’s fractured history. This approach supports both clinical care and moral repair by restoring continuity to the patient’s life narrative.
Ethically, the authors propose a shift in bioethical emphasis away from abstract, individualized rational autonomy toward a model of relational autonomy grounded in vulnerability. This reframing recognizes patients as embedded in relationships and as morally vulnerable during delirium and recovery, thereby imposing duties on clinicians and care teams to attend to identity, testimony, and the social conditions that enable narrative reconstruction.
The article concludes that an integrated response to ICU delirium requires combining biomedical assessment with phenomenological and ethical attention. Recognizing delirium as a disruption to personhood and biography compels clinicians to adopt narrative practices and to reorient ethical frameworks toward relational, vulnerability-aware models. Such changes aim to address both the clinical sequelae (including PICS) and the moral harms (such as epistemic injustice) that delirium can produce.