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PHR Welcomes American College of Emergency Physicians (ACEP) Policy Reversal on “Excited Delirium,” Calls for Further Action

ACEP is the last major medical association in the United States to reject “excited delirium,” a medically baseless diagnosis applied disproportionately to the deaths of Black men in police custody

Physicians for Human Rights (PHR) welcomes the American College of Emergency Physicians’ (ACEP) new public statement that “ACEP does not recognize the use of the term ‘excited delirium’ and its use in clinical settings.” PHR also welcomes ACEP President Christopher Kang’s, MD, FACEP statement in a recent emergency medicine podcast interview that “continued reference” to ACEP’s 2009 white paper on “excited delirium” is “inaccurate and outdated.” 

“Years overdue, ACEP has finally disavowed the pseudoscientific term ‘excited delirium,’” said Joanna Naples-Mitchell, JD, PHR U.S. research advisor and co-author of PHR’s 2022 report on “excited delirium.” “This policy reversal comes after years tireless activism from affected families and research by PHR and others. We look forward to working with ACEP and other stakeholders around the country to end the use of ‘excited delirium’ entirely, and toward a world where medical professionals, not police, respond to medical crises, including suspected delirium.” 

A March 2022 PHR report found that “excited delirium” – endorsed by ACEP for 14 years, starting with an influential 2009 ACEP white paper – is not a valid medical diagnosis or cause of death, yet has been disproportionately used by medical examiners and others to explain the deaths of Black men in police custody. ACEP’s 2009 paper helped perpetuate the notion of “excited delirium” as a distinct, potentially fatal syndrome with defining features that include the racist tropes of “superhuman strength” and “impervious[ness] to pain.” The ACEP white paper has been 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 was the last major U.S. medical association to recognize and endorse the use of the term “excited delirium.” ACEP now joins the American Medical Association, American Psychiatric Association, American Academy of Emergency Medicine, National Association of Medical Examiners, and American College of Medical Toxicology in disavowing the use of the term. 

Following the release of PHR’s report in 2022, PHR met with ACEP’s leadership urging the College to publish a new statement opposing the use of “excited delirium” and withdrawing its 2009 white paper. UC Berkeley Law professor Osagie K. Obasogie, JD, PhD and emergency physician Brooks Walsh, MD joined the meeting to discuss their parallel research on the harms of “excited delirium.” (Obasogie’s research on “excited delirium” is available in the Virginia Law Review; Walsh’s in the Western Journal of Emergency Medicine.) 

Now that ACEP has formally withdrawn its support for “excited delirium,” PHR urges ACEP to make that decision meaningful in practice by: 

  • Updating its written statement to include the ACEP President’s assertion that the 2009 white paper is “inaccurate and outdated;” 
  • Clarifying publicly that while the ACEP Board did approve the 2009 white paper, the Board no longer endorses it and recommends that this paper no longer be referenced for medicolegal use;  
  • Disseminating the new statement on “excited delirium” and educating ACEP membership about this important policy change; 
  • Investing resources and taking action to discourage the use of “excited delirium” both inside and outside the clinical setting; and  
  • Engaging stakeholders who have been directly impacted by the use of “excited delirium” to better understand its lasting harms. 

PHR welcomes ACEP’s important departure from “excited delirium” and urges ACEP leadership to build on this statement by taking constructive steps to address the harmful legacy of the 2009 white paper. In the spirit of “continued multi-disciplinary research, dialogue, and consensus,” PHR looks forward to continued discussions with the College and advocating together for safety and protection of human rights.

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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