Phenomenology of a Biographical Disruption: Delirium in the Critically Ill Patient

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.

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.

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.

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.

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.