The Epicene Solution

Once upon a time, in formal writing pronouns were expected to behave in strict accordance with their antecedents: “The patient should pick up his prescription.” “The surgeon completed her training.” “Everyone should complete his or her form.”

But what if you didn’t know if the patient was male or female? What if the surgeon preferred a nonbinary pronoun? And what about the clunky “his or her” construction (not to mention the impossibly awkward “s/he”) when an indefinite pronoun is the subject (“anyone,” “everyone,” “someone,” and the like)?

One solution, no longer viable, was to select a catchall gendered pronoun—usually the generic “he”—to stand in for all individuals regardless of their actual gender or pronoun preference. This approach to the need for a third-person singular pronoun has largely been discarded as sexist language (and in many cases just flat-out wrong): “Each patient needs to get regular checkups, including visits to his primary care physician and gynecologist.”

Sometimes it’s simple enough to reword a sentence by using the plural without affecting the meaning: “A researcher should cite her sources” could become “Researchers should cite their sources.”

However, rewriting is not always possible or desirable, and performing linguistic acrobatics just to avoid violating a grammar rule can be time-consuming and lead to unclear or awkward prose.

Enter “they.”

Because the English language does not have a gender-neutral third-person singular pronoun readily available, speakers and writers have often turned to the handy “they” to fill this need. “They” is a good solution because it’s a familiar (not newly coined) word, it’s short, and it’s inclusive of all people, which helps writers avoid making assumptions about gender. In this manner, it’s considered an epicene pronoun (according to Merriam-Webster’s, “having but one form to indicate either sex”).

In addition, “they” can be useful in articles in which a person’s identifiability is a concern (eg, in case reports in medical journals or in news stories): “One of the patients in the waiting room reported that they had used illicit substances.”

Nearly all of the major stylebooks and many authoritative language sources now allow or even encourage the use of what’s often called the “singular they”: the newly published 11th edition of the AMA Manual of Style,1 Chicago Manual of Style,2 APA Publication Manual,3 AP Stylebook,4 and Merriam-Webster’s5 dictionary (whose editors selected it as “Word of the Year6 for 2019).

Yet the singular “they” is hardly new. Some sources have traced its use back as far as Middle English. Beloved authors have used it, such as Jane Austen: “But to expose the former faults of any person, without knowing what their present feelings were, seemed unjustifiable” (Pride and Prejudice). It also turns up in darker places: “But it was Jonathan, and he was my husband, and we didn’t know anybody who saw us, and we didn’t care if they did, so on we walked” (Bram Stoker, Dracula). The singular “they” even appears in the Declaration of Helsinki: “The physician must fully inform the patient which aspects of their care are related to the research.”

So exactly how is the singular “they” used? When functioning as a singular pronoun it should still take a plural verb. This isn’t revolutionary—we treat singular “you” the same way: “You are a good writer” not “You is a good writer.” When used as a subject, it’s “they.” When functioning as an object, it’s “them”: “Every patient had the informed consent passage read to them.” As a possessive pronoun, it’s “their”: “Every author needs to submit their authorship form.” And as to the reflexive form, “themselves” is currently the most common usage: “The patient hurt themselves.”

Some writers and editors may balk at this construction because formal grammar education teaches that pronoun agreement (matching on number, person, and gender) is essential to correct grammar. But language is nothing if not ever changing to reflect the world in which it is used, and “they” is here to stay.

References and Links 



Stacy L Christiansen, MA, is Managing Editor of JAMA and Chair of the AMA Manual of Style committee.