Montrealer vows to continue hunger strike for ‘X’ gender on Quebec health card
(www.winnipegfreepress.com)
That's the crux of the issue here: someone does feel the need to not fill out the field (i.e. filling it in with an "X"), and the health authority is forcing them to use either "M" or "F". They are fighting for that right because they are intersex or trans, but an identity card with one or two fields is not the place to explain, because biology is complex. For medical information, you read their medical charts or talk to the patient.