Eliminating Biased Language: A Goal for Everyone
Beth Ulrich, EdD, RN, CHE

IWe often don’t realize what we say or how we say it. A number of months ago, I sent ANNA Past President Dawn Brennan a manuscript to review. When I got the review back, she had crossed out the phrase “diabetic patient” throughout and replaced it with “patient with diabetes.” Then, a short while later, I was updating my notes in preparation for conducting a writing workshop and read the American Psychological Association’s (APA) guidelines for removing bias in language. As a result of those consciousness raising events, last year, the Nephrology Nursing Journal set a long-term goal of eliminating biased language in our publication.

Consider the bias that may be present in the language you use everyday. Do you talk about hemodialysis patients, CKD patients, diabetics, or non-compliant patients? Our collective consciousness has been raised previously about terms that convey biases related to ethnicity, gender, and race. Now it’s time to think about how we refer to persons with illnesses and disabilities.
 
Basic Principles Offered by APA
The APA offers some basic principles on using what they term as non-handicapping language (www.apastyle.org/ disabilities.html).

• Put people first, not their disability. Problematic:  CKD patient, hemodialysis patient.  Preferred:  Individual with CKD or patient with CKD, patient or person requiring hemodialysis.
• Don’t label people by their disability. Problematic: diabetics.  Preferred: people with diabetes.
• People are only patients if the illness status is under discussion or they are currently in a hospital. 
• Don’t overextend the severity of the disability.Saying “the physically disabled” sounds like the person can’t do all physical activities. Saying “an individual with a physical disability” better describes a person who has some physical limitations.
• Use emotionally neutral words and avoid offensive expressions. “Individual who had a stroke” is preferable to “stroke victim.” Avoid terms like victim, affliction, suffering, cripple, and deformed.
• Emphasize abilities not limitations.“Uses a wheelchair” is preferable to “confined to a wheelchair.”

Let’s View People as Individuals First
We need to see people as individuals first — not only by the diseases they may have or the services they may require. Too often, we unintentionally use terms like those described above that diminish or depersonalize people. Our experience at the journal is that we’ve used many of these terms for so long that we sometimes read past them without even seeing them.
 
The other thing we’ve noticed is that many people talk about dialysis patients or even patients on dialysis when they mean patients on hemodialysis. We seem to have developed a bias that says dialysis = hemodialysis. It does not.

When we send back manuscripts to authors with requests to correct the biased language or ask if, when they use the term “dialysis,” they really meant “hemodialysis,” some react as if we’re being too picky while others sound almost embarrassed as if we think they did something wrong intentionally. Neither, of course, is true. We are doing what we hope you will do – to think about the people we care for first as individuals and to not make assumptions about people or treatments.

It hasn’t been easy to eliminate the non-biased language and something may still slip through occasionally, but we’re trying. We hope you will too.

Beth Ulrich, EdD, RN, CHE
Editor
E-mail: BethUlrich@aol.com