The erosion of inclusive language in medical documents

In January 2025, President Donald Trump issued Executive Order 14168, titled Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. This directive mandated that federal agencies cease recognizing gender identity, replace "gender" with "sex" in all official documents, and eliminate references to transgender and nonbinary individuals from public health materials. While the immediate effects were most apparent in federal communications and data, the ripple effects are now being felt in medical documents, including informed consent forms, which traditionally aim to respect patient autonomy and ensure clarity.

The immediate fallout: a shift in medical terminology

Following the executive order, federal agencies such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Health and Human Services (HHS) were instructed to remove or alter over 8,000 web pages and approximately 3,000 datasets. These deletions primarily targeted content related to diversity, equity, and inclusion (DEI), as well as gender identity and transgender health issues. Terms like "transgender", "nonbinary", "assigned male at birth", and "pregnant person" were banned, leading to the erasure of vital health information and resources for marginalized communities.

This linguistic purge extended beyond public health communications. Medical institutions and research organizations, many of which rely on federal guidelines, began to revise their documents to align with the new mandates. Informed consent forms, which are crucial for patient autonomy, were among the documents affected. These forms, designed to ensure that patients understand the risks, benefits, and alternatives to medical procedures, traditionally use inclusive language to accommodate diverse patient populations.

The impact on informed consent forms

Informed consent documents are foundational to ethical medical practice. They ensure that patients are fully aware of their medical choices and that their rights are respected. The introduction of restrictive language policies has several implications:

1. Exclusion of nonbinary and transgender patients: by eliminating terms like "gender identity" and "pregnant person", these forms risk alienating nonbinary and transgender individuals. For instance, a transgender man seeking reproductive healthcare might find a form that only refers to "women" or "female patients", disregarding his identity and potentially deterring him from seeking care.

2. Loss of clarity and precision: the removal of specific terms can lead to vague and imprecise language. For example, replacing "assigned female at birth" with "female" may obscure the distinction between biological sex and gender identity, leading to misunderstandings about medical histories and needs.

3. Erosion of trust: patients who feel that their identities are not acknowledged may lose trust in healthcare providers. This mistrust can lead to decreased utilization of healthcare services, particularly among marginalized groups who already face systemic barriers to care.

4. Legal and ethical concerns: the use of non-inclusive language may expose healthcare providers to legal challenges. Patients who feel that their informed consent was not truly informed due to the exclusion of relevant identity information might pursue legal action, citing violations of their rights.