The cost of survival: iatrogenic trauma, post-intensive care syndrome, and the ethics of critical care medicine

Advances in medicine have substantially improved survivorship from critical illness, prompting growing attention to the quality of that survival. Post-intensive care syndrome (PICS) is a constellation of symptoms involving cognitive, physical, and psychological deficits that persist long after discharge, affecting 43-96% of intensive care unit (ICU) survivors and imposing lasting burdens on patients, families, and the healthcare system. Existing literature on PICS has primarily focused on the severity of the inciting illness as the primary driver of adverse outcomes, while comparatively less attention has been given to the role of critical care settings as a potential source of iatrogenic harm. This thesis explores the ways in which the ICU environment, while lifesaving, creates conditions of psychological stress that may precipitate iatrogenic trauma, particularly among vulnerable populations, such as those with pre-existing mental health challenges, prior traumatic experiences, and limited social support. In doing so, it examines the psychological and cognitive sequelae of critical illness, the ethical responsibilities clinicians bear to mitigate the modifiable risk factors contributing to PICS, and the practical strategies for trauma-informed critical care that may fulfill that obligation.