Employees of Johns Hopkins Medicine (JHM) in Maryland were recently given a comprehensive guide for pronoun usage that covers 50 different gender-neutral pronoun options, according to Fox News.

As the program director for JHM’s LGBTQ+ Equity and Education Paula Neira explained, a policy enacted last March allows for both healthcare providers and patients to choose what name to put on their wristbands and badges, according to Fox News.

The JHM handbook detailing gender-neutral pronouns like ve, xe, and per is meant to go hand-in-hand with this practice of identifying people according to their chosen names.

Formal titles corresponding to chosen gender identities are included in the handbook, such as “Mr.” for men, “Ms.” for women, and “Mx.” for people identifying as nonbinary.

It also provides examples of how different pronouns might be used.

For instance, “Ae cleaned the office all by aerself” demonstrates both the subjective and reflexive uses of the pronoun “ae.”

More examples include “I gave faer the key” and “That is zirs.”

A spokesperson for JHM told Fox News that the ID policy is part of the institution’s dedication to “fostering a supportive, diverse, and inclusive community.”

“There are many reasons individuals may choose how they are identified, for example, some people may prefer to use a middle name, have cultural distinctions or preferences, or have gender ambiguous names,” the spokesperson explained.

The ID policy is also in line with federal and state regulations, with a legislative change last year in Maryland allowing employees to use a chosen name rather than that appearing on their legal identification.

Some exceptions to this include Maryland state police officers and healthcare professionals licensed by the federal government, with both groups being required to carry ID badges matching their legal names, as Neira explained, according to Fox News.

Not everyone in the medical community is on board with these changes.

Among the critics is Dr. Stanley Goldfarb, who chairs a group called Do No Harm that gathers like-minded healthcare professionals seeking to “Protect healthcare from a radical, divisive, and discriminatory ideology,” according to its website.

Once the associate dean for curriculum at the University of Pennsylvania School of Medicine, Goldfarb referred to initiatives like that seen at JHM as introducing political bias and muddying communication in the medical field.

“The most important component of the physician patient relationship is the ability to have clear and appropriate communication,” Goldfarb said, according to Fox News. “To use pronouns associated with one’s identification badge suggests that an individual has a particular ideological and political perspective.”

As The Dallas Express has reported, the usage of preferred pronouns seems to be falling out of favor among top employers in the Dallas-Fort Worth area.

Still, the City of Dallas itself has issued internal guidelines mandating that City staff support and refer to other employees by their chosen name and pronouns, irrespective of whether this violates a sincerely held religious belief, as first reported by The Dallas Express.