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Emergency Medicine Association Finally Withdraws its Approval of Policy Paper Endorsing “Excited Delirium” as Cause of Death

Following clinician advocacy and PHR report, the American College of Emergency Physicians (ACEP) withdraws its support for infamous 2009 white paper that backed “excited delirium"

The American College of Emergency Physicians (ACEP) board of directors adopted a resolution voted on by the ACEP Council that officially withdraws its approval of its 2009 white paper endorsing the medically baseless concept of “excited delirium,” which has been misused to explain deaths in police custody for decades. ACEP’s decision removed the final pillar of support from any U.S. medical association for the use of “excited delirium” as a diagnosis or cause of death. In 2022, PHR research showed “excited delirium” to be a spurious diagnosis rooted in racism rather than in scientific evidence. 

“This is a major win for police accountability, justice, and public safety. At last, ACEP has clearly stated that it no longer endorses the influential 2009 ACEP white paper,” said Michele Heisler, MD, MPA, medical director at PHR, professor of internal medicine at University of Michigan, and a co-author of the 2022 PHR report on “excited delirium.” “Now that there is no remaining medical association support for ‘excited delirium,’ law enforcement, clinicians, medical examiners, and the courts should never use this outdated, baseless term to explain deaths in custody or inform first responder training.”  

“It is heartening that ACEP has now joined all other U.S. medical and psychiatric associations in unequivocally repudiating ‘excited delirium.’ We applaud the ACEP members who have worked tirelessly to advocate for reform in their association and who pushed through this landmark resolution,” said Dr. Heisler.  

The resolution builds on an April 2023 ACEP statement that the group does not recognize “excited delirium.” PHR welcomed the statement at the time while issuing a series of recommendations to make it meaningful in practice. ACEP has now adopted the majority of PHR’s recommendations, chief among them withdrawing its 2009 white paper. 

“Now that ACEP has broken with its past position, we hope to see the organization educate its membership about this important policy change and invest in resources to discourage the use of ‘excited delirium’ inside and outside the clinical setting,” said Dr. Heisler. 

The resolution comes just days after California became the first state in the nation to ban “excited delirium,” prohibiting references to it in death certificates and autopsy reports, police reports, and civil litigation. 

ACEP’s white paper helped perpetuate the notion of “excited delirium” as a distinct, potentially fatal syndrome with defining features that rely on racist tropes of “superhuman strength” and “impervious[ness] to pain.” The white paper was also used by expert witnesses to buttress claims of deaths from “excited delirium” in civil lawsuits and criminal investigations related to deaths in law enforcement custody, such as those of Martin Harrison (2010) and Daniel Prude (2020), both documented in PHR’s report.   

“ACEP’s withdrawal of its 2009 white paper reflects a clear U.S. medical consensus that ‘excited delirium’ is a harmful concept with no basis in science,” said Joanna Naples-Mitchell, JD, U.S. research advisor at PHR and a co-author of PHR’s report on “excited delirium.”

“Families who have lost loved ones to deaths in custody attributed to ‘excited delirium’ have waited years for this moment. PHR encourages ACEP to engage stakeholders who have been directly impacted by the use of ‘excited delirium’ to better understand its lasting harms and ensure future guidance is patient-centered,” said Naples-Mitchell.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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