Don't Use 'Excited Delirium' As Cause of Death, Says Medical Examiners Group

by Staff Writer
April 4, 2023 at 12:13 PM UTC

Excited delerium

Clinical Relevance: Most medical groups advise against using the term “excited delirium”

  • The National Association of Medical Examiners issued a statement asking its members to stop listing excited delirium as a cause of death.
  • The term, used since the 1980s, is controversial for its use to justify police force, as it was in the George Floyd case.
  • Some experts warn that regardless of what words are used, police will still encounter subjects exhibiting the behaviors associated with the phrase.

The National Association of Medical Examiners (NAME) has instructed its members to stop listing “excited delirium” on death certificates. The term has been used for too long to justify police force, the group said.

“Although the terms ‘Excited Delirium’ or ‘Excited Delirium Syndrome’ have been used by forensic pathologists as a cause of death in the past, these terms are not endorsed or recognized in renewed classifications of the WHO, ICD10, and DSMV…” the position statement read, in part. 

The organization supported determining and naming the underlying cause for the delirious state in death certification. The position carries no legal weight but will be influential with the group’s members. 

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NAME becomes the latest professional medical organization to condemn the diagnosis. The American Psychiatric Association (APA) and the American Medical Association (AMA) have also criticized it in recent years. Both organizations denounce the practice of police using drugs such as ketamine to sedate a person without a medical reason. 

“In some reported cases, it is questionable whether the person identified as having an ‘excited delirium’ actually had any medical condition warranting its use. Many sedating medications, used in outside of hospital contexts, including ketamine, have significant risks, including respiratory suppression. Supporting respiration may be challenging outside of a hospital setting, where it may require intensive medical oversight or involvement,” the APA said

Experts have been citing “excited delirium” since the 1980s to describe a mental state characterized by agitation, delirium, and hyperthermia. It can lead to a sudden and unexpected death, they claim. 

Medical examiners frequently list excited delirium as a cause or contributing factor in police-related deaths. In the George Floyd case, Minneapolis police officer Derek Chauvin refused to roll Floyd onto his side to help him breathe. “I am worried about excited delirium or whatever,” another officer told Chauvin, according to an official police report. Floyd later died after Chauvin knelt on his neck for nearly nine minutes. 

The Floyd case led to renewed scrutiny of the term’s use in other cases involving police use of force. The Minneapolis Police Department recently agreed to stop injecting sedatives like ketamine into people who they suspect have excited delirium. They entered into a court agreement with the Minnesota Department of Human Rights, which called out the practice as part of a pattern of racially biased policing in the city.

However, not all experts agree with the move away from the description.  John Peters, president of the Institute for the Prevention of In-Custody Deaths, a group that provides training to police officers, told the San Diego Union-Tribune that its removal could lead to more investigations of police officers. 

Peters suggested the behaviors associated with excited delirium can be triggered by use of illicit drugs and that they ”will continue regardless of what we call it.”

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