A doctors group calls its ‘excited delirium’ paper outdated and withdraws its approval

by Michael Nguyen
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Excited Delirium Controversy

A prominent association of medical professionals, the American College of Emergency Physicians, has taken a significant step by officially retracting its endorsement of a 2009 paper concerning the controversial concept of “excited delirium.” This decision comes amidst mounting criticism that the paper has been wielded to justify excessive force by law enforcement.

In a formal statement, the American College of Emergency Physicians declared the paper to be outdated and explicitly advised its members not to employ the term “excited delirium” in their testimonies within civil or criminal cases. This pivotal decision was reached following a vote by the group’s directors in Philadelphia.

The implications of this action are profound. Dr. Brooks Walsh, an emergency physician from Connecticut who actively advocated for a more resolute stance, emphasized that this withdrawal means that in cases where individuals die while under restraint, the defense cannot invoke “excited delirium” as a causal factor nor cite ACEP’s prior endorsement to support their arguments.

Earlier this week, California became the first state to enact legislation prohibiting the use of “excited delirium” and related terms as a listed cause of death in autopsies. Furthermore, it bars law enforcement officers from incorporating this terminology in their reports to characterize individuals’ behavior.

This is not the first instance of medical organizations distancing themselves from the term. In March, the National Association of Medical Examiners rejected it as a cause of death, while the American Medical Association had previously dismissed “excited delirium” as a valid diagnosis. Critics have long contended that it lacks scientific basis and is intertwined with racial bias.

The 2009 report by emergency physicians described symptoms of “excited delirium” as encompassing extraordinary strength, high pain tolerance, and peculiar behavior while categorizing it as “potentially life-threatening.” However, Dr. Walsh argued that the document perpetuated and institutionalized racial stereotypes.

Notably, this 14-year-old publication has left an enduring impact on police training and has been invoked in cases involving police custody deaths, particularly those concerning Black individuals who perished while being restrained. Attorneys defending law enforcement officers have often cited this paper to introduce testimony regarding “excited delirium.”

In 2021, the paper played a role in the New York attorney general’s report on the investigation into the death of Daniel Prude, a 41-year-old Black man. A grand jury did not bring charges against the involved police officers in that case.

Moreover, “excited delirium” emerged during the trial of former Minneapolis police officer Derek Chauvin in 2021, who was subsequently convicted in the death of George Floyd. Recently, this term resurfaced in the ongoing trials of police officers facing charges in the deaths of Elijah McClain in Colorado and Manuel Ellis in Washington state, all of whom were Black men who died while in police custody.

While the American College of Emergency Physicians had previously distanced itself from the concept, this formal withdrawal of support signifies a more resolute stance. As Joanna Naples-Mitchell, an attorney and research adviser for Physicians for Human Rights, remarked, it presents an opportunity for ACEP to definitively sever ties with a contentious past.

Frequently Asked Questions (FAQs) about Excited Delirium Controversy

What is the significance of the American College of Emergency Physicians withdrawing its approval of the 2009 “excited delirium” paper?

The American College of Emergency Physicians’ withdrawal of approval is significant because it reflects a growing acknowledgment of concerns that the paper has been misused to justify excessive force by law enforcement. This decision marks a break from the past and signifies a more critical stance on the controversial concept of “excited delirium.”

What does this withdrawal mean for legal cases involving deaths in police custody?

This withdrawal means that the term “excited delirium” should not be cited by medical professionals affiliated with ACEP in civil or criminal cases as a cause of death or a justification for excessive force. It aims to prevent the paper’s endorsement from being used to bolster legal defenses in such cases.

How have other medical organizations reacted to the concept of “excited delirium”?

Other medical organizations, including the National Association of Medical Examiners and the American Medical Association, have also distanced themselves from “excited delirium.” They have rejected it as a valid cause of death, citing concerns about its scientific validity and associations with racial bias.

Why is there controversy surrounding the 2009 paper on “excited delirium”?

The controversy arises from critics who argue that the paper lacks scientific credibility and has been used to rationalize excessive use of force by police. They assert that the concept of “excited delirium” perpetuates racial stereotypes and is not supported by rigorous medical evidence.

What impact has the 2009 paper had on law enforcement and legal cases?

The paper has shaped police training and has been cited in cases involving individuals who died in police custody, particularly Black men. Attorneys defending law enforcement officers have used the paper to introduce testimony on “excited delirium” in these cases, which has contributed to the controversy surrounding its use.

Are there legal implications for the use of “excited delirium” terminology?

Yes, California recently passed legislation prohibiting the use of “excited delirium” and related terms as a listed cause of death in autopsies. Additionally, it forbids law enforcement officers from using this terminology in their reports to describe individuals’ behavior. This legal action signifies a broader effort to address the concerns associated with this concept.

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