AMA opposes ‘excited delirium’ as a diagnosis, citing forced sedation

AMA opposes 'excited delirium' as a diagnosis, citing forced sedation

The American Medical Association on Tuesday said it oppose the use of “excited delirium syndrome” as a clinical diagnosis, contending the term too often inappropriately justifies excessive police force and the forced sedation of individuals for no legitimate medical reason during encounters with law enforcement.

The new policy adopted this week during the AMA’s special meeting of its house of delegates opposes using “excited delirium” as the sole basis behind the use of excessive force by police officers. A controversial concept among many in healthcare, excited delirium is often described as being in a state of extreme agitation, with symptoms that include extreme physical strength, aggressive behavioral, usually caused by use of a drug stimulant.

Studies have found a diagnosis of excited delirium was associated with a higher likelihood of death and being restrained more aggressively compared to individuals not given that diagnosis.

Many have pointed out excited delirium is often cited as a reason for excessive force by police. Black men are approximately 2.5 times more likely to be killed by police over the course of their life than white men, according to a 2019 study published in the journal, Proceedings of the National Academy of Sciences of the United States of America.

As part of the new policy, the AMA also opposes the use of drugs like ketamine to sedate agitated individuals during police calls, stating those types of medications can pose a health risk when administered outside of hospital settings. The practice of sedating individuals during police encounters has long been controversial, with critics arguing administering such medications often without the consent of the individual receiving the injection violated their civil rights.

Such concerns prompted more than 60 patient and medical research advocates in 2018 to write a letter to the U.S. Food and Drug Administration requesting they investigate two clinical trials conducted at Hennepin County Medical Center between 2015 and 2017 for possible ethical violations. Critics alleged the hospital enrolled individuals without their consent into a trial that compared the safety and efficacy of ketamine to two other sedatives and that some members of the Minneapolis Police Department had asked Hennepin County paramedics to use ketamine to sedate suspects against their will.

Public backlash over the trials prompted Hennepin County Medical Center’s parent company, Hennepin Healthcare, to make a statement at the time promising the organization would be more transparent moving forward.

Concerns over forced sedation and restraint of patients, especially patients of color, was the impetus behind a petition published last month by a number of Hennepin Healthcare employees. They called on the system’s leaders to review how often patients were being restrained and sedated, as well as end the hospital’s training of law enforcement on excited delirium.

“For far too long, sedatives like ketamine and misapplied diagnoses like ‘excited delirium’ have been misused during law enforcement interactions and outside of medical settings – a manifestation of systemic racism that has unnecessarily dangerous and deadly consequences for our Black and Brown patients,” AMA President-elect Dr. Gerald Harmon said in a written statement. “As physicians and leaders in medicine, it is our duty to define the medical terms that are being used to justify inappropriate and discriminatory actions by non-health care professionals.”

Several major health organizations, including the AMA, the World Health Organization and the American Psychiatric Association denounced excited delirium syndrome as a diagnosis.

In response to the AMA’s new policy, the APA on Tuesday applauded the move, stating it adopted a similar position statement last year. The association said the term didn’t meaningfully describe and convey information about a person.

“Excited delirium has been invoked to explain or justify injury or death to individuals in police custody, and it is disproportionately applied to Black men,” according to the APA.

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Marie Maynes
Marie Maynes is a Sports enthusiast and writes for the Sports section of ANH.