News organizations everywhere had an important editorial decision to make in early January 2018 when President Trump categorized certain countries in a defamatory manner during a closed-door discussion about immigration in the Oval Office with Senators Dick Durbin and Lindsay Graham, among others.

• “Trump decries immigrants from ‘shithole countries’ coming to US” (CNN headline)
• “Trump derides protections for immigrants from ‘shithole’ countries” (Washington Post headline)
• “‘Fox & Friends’ host called for Trump to clarify ‘s—hole’ comment shortly before denial” (The Hill headline)

In scientific reporting, as in politics and life, things sometimes get ugly, and when they do, we turn to apologetic quotation marks. In the examples above, the term shithole is a part of the story; without using the offensive term, the story’s meaning is lost. It’s interesting that these 3 examples apply the apologetic quotation marks in 3 different ways. The first example includes “countries” within the quotation marks, which is not necessary. The Washington Post example gets it right. And the example from The Hill is not fooling anyone. If you’re going to include it, include it. Crossing out a few letters in the offensive term is the literary equivalent to putting black bars over a patient’s eyes to make the patient “unidentifiable.” (←ironic use of apologetic quotation marks.) 

This is not a picture of my cat:

This is not an offensive word:

S—HOLE

You get the point.

The revised edition of the AMA Manual of Style will provide expanded guidance in the “Apologetic Quotation Marks” section of the Punctuation chapter, which currently only states that apologetic quotation marks are “sometimes used around words for special effect or to indicate irony.” Additional guidance will note that in some instances, the use of a potentially offensive term might be unavoidable if it is a direct quotation that is important to an article (eg, in a news story). In such cases, the offensive term may be published within quotation marks. The New York Times occasionally opens up its policy on including offensive terms in print. Ultimately, whether or not to include offensive language in an article is an editorial decision that comes down to how the term relates to the meaning of a story.—Lauren Fischer