---
title: "Delirium in the Critically Ill: Phenomenology, Identity Disruption, and Ethical Implications"
id: "pubmed-42670598"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42670598"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42670598/"
doi: "10.1111/jep.70583"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Delirium in the Critically Ill: Phenomenology, Identity Disruption, and Ethical Implications
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42670598
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42670598/)
- **DOI:** [10.1111/jep.70583](https://doi.org/10.1111%2Fjep.70583)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Delirium in the ICU is an acute neurocognitive syndrome that can affect up to **80%** of patients receiving mechanical ventilation, commonly described by biomedical criteria such as the **DSM-5**. - Biomedical diagnostic frameworks may fail to capture the profound subjective and existential changes experienced by patients; delirium can produce an ontological rupture in the patient’s sense of self. - The study integrates clinical evidence (pathophysiology and meta-analyses) with philosophical perspectives — including the phenomenology of perception, narrative identity, and the ethics of vulnerability — via an interdisciplinary conceptual analysis. - Phenomenologically, delirium is described as suspending the **"intentional arc"**, causing a collapse of the lived world, fragmentation of temporality, and distorted experience of others. - Subphenotypes such as **hypoactive delirium** can lead to **epistemic injustice**, where the patient’s subjective testimony is silenced or devalued by clinicians and systems. - Post‑Intensive Care Syndrome (**PICS**) is reframed as a **"biographical disruption"**, a wound to selfhood that continues beyond the ICU episode. - Ethical implications include a need to move bioethics beyond abstract rational autonomy toward **relational autonomy** grounded in vulnerability and interdependence. - Clinical practice should broaden assessment beyond pathophysiology to include **narrative competence**, enabling reconstruction of the patient’s fractured personal history and supporting identity repair. - The study calls for clinicians to recognize the moral and epistemic dimensions of delirium and adopt approaches that attend to patients’ narrative and relational needs as part of recovery.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliation * 1 Hospital Universitario de la Princesa, Madrid, Spain. * PMID: **42670598** * DOI: [ 10.1111/jep.70583 ](https://doi.org/10.1111/jep.70583) Item in Clipboard # Phenomenology of a Biographical Disruption: Delirium in the Critically Ill Patient A Canabal-Berlanga et al. J Eval Clin Pract. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID J Eval Clin Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Eval+Clin+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Eval+Clin+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) . 2026 Sep;32(6):e70583. doi: 10.1111/jep.70583. ### Authors [A Canabal-Berlanga](https://pubmed.ncbi.nlm.nih.gov/?term=Canabal-Berlanga+A&cauthor_id=42670598)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670598/#short-view-affiliation-1 "Hospital Universitario de la Princesa, Madrid, Spain."), [C Alvargonzález](https://pubmed.ncbi.nlm.nih.gov/?term=Alvargonz%C3%A1lez+C&cauthor_id=42670598)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670598/#short-view-affiliation-1 "Hospital Universitario de la Princesa, Madrid, Spain."), [B Abad](https://pubmed.ncbi.nlm.nih.gov/?term=Abad+B&cauthor_id=42670598)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670598/#short-view-affiliation-1 "Hospital Universitario de la Princesa, Madrid, Spain."), [E Rosas](https://pubmed.ncbi.nlm.nih.gov/?term=Rosas+E&cauthor_id=42670598)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670598/#short-view-affiliation-1 "Hospital Universitario de la Princesa, Madrid, Spain.") ### Affiliation * 1 Hospital Universitario de la Princesa, Madrid, Spain. * PMID: **42670598** * DOI: [ 10.1111/jep.70583 ](https://doi.org/10.1111/jep.70583) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Rationale:** Delirium in the Intensive Care Unit (ICU) is an acute neurocognitive syndrome affecting up to 80% of patients on mechanical ventilation. While traditionally defined by biomedical criteria (DSM-5), these metrics often overlook the profound ontological rupture and subjective alienation experienced by the patient. **Aims and objectives:** This study aims to integrate clinical evidence with phenomenological reflection to evaluate how delirium alters patient identity and to define the resulting ethical responsibilities for the clinical team. **Method:** An interdisciplinary conceptual analysis was conducted, merging pathophysiological data and clinical meta-analyses with philosophical frameworks, including the phenomenology of perception, narrative identity and the ethics of vulnerability. **Results:** Delirium suspends the 'intentional arc', leading to a collapse of the lived world, fragmented temporality and distorted otherness. Subphenotypes like hypoactive delirium often result in 'epistemic injustice' by silencing the patient's subjective testimony. Post-Intensive Care Syndrome (PICS) is identified as a 'biographical disruption' and a wound to selfhood. **Conclusion:** Clinical evaluation must transcend pathophysiology to include 'narrative competence', enabling the reconstruction of the patient's fractured history. Bioethics should shift from abstract rational autonomy toward a model of 'relational autonomy' grounded in vulnerability. **Keywords:** bioethics; delirium; intensive care units; medical; narrative medicine; patient outcome assessment; philosophy. © 2026 John Wiley & Sons Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Personality Theories. ](https://pubmed.ncbi.nlm.nih.gov/42475469/) Gallios JM, Iyer V, Kaylor LE.Gallios JM, et al.2026 Jun 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–.2026 Jun 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–.PMID: 42475469Free Books & Documents. * [ Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review. ](https://pubmed.ncbi.nlm.nih.gov/28498176/) Santos E, Cardoso D, Neves H, Cunha M, Rodrigues M, Apóstolo J.Santos E, et al.JBI Database System Rev Implement Rep. 2017 May;15(5):1440-1472. doi: 10.11124/JBISRIR-2017-003391.JBI Database System Rev Implement Rep. 2017.PMID: 28498176 * [ Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings. ](https://pubmed.ncbi.nlm.nih.gov/37987526/) Miranda F, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P.Miranda F, et al.Cochrane Database Syst Rev. 2023 Nov 21;11(11):CD013126. doi: 10.1002/14651858.CD013126.pub2.Cochrane Database Syst Rev. 2023.PMID: 37987526Free PMC article. * [ Effects of narrative nursing on delirium and outcomes in mechanically ventilated ICU patients: a randomized trial. ](https://pubmed.ncbi.nlm.nih.gov/41250164/) Lei Y, Song Y, Wang Y, Liu J, Liu D, Shi C, He H, Zhang B, Cai Y.Lei Y, et al.Trials. 2025 Nov 17;26(1):516. doi: 10.1186/s13063-025-09249-z.Trials. 2025.PMID: 41250164Free PMC article.Clinical Trial. * [ Neurological Complications in Intensive Care Units: From Delirium to Long-Term Cognitive Dysfunction-A Narrative Review. ](https://pubmed.ncbi.nlm.nih.gov/41976780/) Szczupak M, Kobak J, Wierzchowska J, Dąbrowska A, Mędrzycka-Dąbrowska W, Krupa-Nurcek S.Szczupak M, et al.J Clin Med. 2026 Mar 24;15(7):2478. doi: 10.3390/jcm15072478.J Clin Med. 2026.PMID: 41976780Free PMC article.Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42670598) ## References 1. 1. A. Y. Leong, S. Edginton, L. A. Lee, et al., “Prevalence and Incidence of ICU Delirium and Pain: A Systematic Review and Meta‐Analysis,” Intensive Care Medicine 51, no. 11 (2025): 2093–2103, . 2. 1. T. E. Goldberg, C. Chen, Y. Wang, et al., “Association of Delirium With Long‐Term Cognitive Decline: A Meta‐Analysis,” JAMA Neurology 77, no. 11 (2020): 1373–1381, . 3. 1. American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, 2022. 5th ed. 4. 1. P. Ricoeur, Soi‐Même Comme Un Otro. Seuil, 1990. 5. 1. H. Carel, Phenomenology of Illness. Oxford University Press, 2016. Show all 37 references ## MeSH terms * Critical Care / ethics Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Critical+Care%2Fethics%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Critical+Care) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) * Critical Illness* / psychology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Critical+Illness%2Fpsychology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Critical+Illness) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) * Delirium* / physiopathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Delirium%2Fphysiopathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Delirium) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) * Delirium* / psychology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Delirium%2Fpsychology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Delirium) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) * Intensive Care Units Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Intensive+Care+Units%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Intensive+Care+Units) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) * Respiration, Artificial / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Respiration%2C+Artificial%2Fadverse+effects%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Respiration%2C+Artificial) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) ## Supplementary concepts * postintensive care syndrome Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22postintensive+care+syndrome%22%5Bnm%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=postintensive+care+syndrome) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670598/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42670598/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42670598%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42670598/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42670598%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42670598%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42670598/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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