When registering individuals who are unresponsive to stimuli, unconscious, unaware, or lacking alertness, it has been customary to assign them the names John Doe or Jane Doe, based on physical characteristics, while also assigning their sex accordingly. If their family members or legal guardians arrive or are contacted, their sex is determined based on their recollections until the individuals themselves awaken and become capable of expressing their gender preferences, affirming or modifying their registration details. However, in cases where individuals suffer from chronic neurological conditions like dementia, they may never regain consciousness or responsiveness, leaving their registration details unchanged as perceived by those registering them or as per the documented recollections provided by their family members or legal guardians.

Now, the question arises: Does it truly matter how these unresponsive individuals are perceived or addressed while receiving health care? Would they respond better to health care if their health care professionals were aware of their self-identified names and used gender-appropriate pronouns, rather than referring to them as John Doe or Jane Doe in the absence of alternatives? Historically, has it been easier for individuals recovering from general anesthesia when their anesthesia providers addressed them by their self-identified names and used gender-appropriate pronouns? Consequently, the question arises whether it is time to implement gender-neutral registration policies for unidentified individuals, registering all of them as JJ Roe with an unknown gender until they regain consciousness, awareness, alertness, and responsiveness, at which point their registration details can be updated.

Using JJ as the first name, an abbreviation of John-Jane, takes advantage of the system’s historical familiarity with John-Jane, making it easier to transition to JJ as a first name. Additionally, the gender-neutral last name “Roe,” derived from “Richard Roe” and inspired by deer, shares a similar sound to the replaced last name “Doe,” which was also inspired by female deer. This similarity may facilitate a smoother transition within the system. In summary, as even conscious individuals may increasingly choose not to disclose their gender during registration, it would be a forward-thinking registration policy to designate the gender of all unidentified individuals as unknown until they awaken and self-identify their gender, after becoming conscious, aware, alert, and responsive to stimuli.

Deepak Gupta is an anesthesiologist.