ICU Psychosis and Patient Autonomy: Some Thoughts from the Inside
The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of MedicinePublished 1 August 2005
Cheryl Misak
Citations30
SJR quartileQ1
SJR score0.66
SNIP1.11
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TL;DR
The recurring theme in this paper is ICU psychosis.
Abstract
I shall draw on my experience of being an ICU patient to make some practical, ethical, and philosophical points about the care of the critically ill. The recurring theme in this paper is ICU psychosis. I suggest that discharged patients ought to be educated about it; I discuss the obstacles in the way of accurately measuring it; I argue that we must rethink autonomy in light of it; and I suggest that the self disintegrates in the face of it.
Keywords
PsychologyMedicineHealth Professions
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