The debate between Pennsylvania Senatorial candidates John Fetterman and Mehmet Oz, MD, in late October was a remarkable moment. Fetterman had a stroke in early May 2022 and had few public appearances in the run-up to the election as he underwent rehabilitation. At the time of the stroke, surgeons removed a blood clot from his brain and implanted a pacemaker. His decision to debate Dr Oz surprised some who wondered how he would hold up during a high-pressure debate.

Fetterman used a teleprompter during the debate and had moments when he repeated words and struggled with long pauses. As I watched the debate, I felt uncomfortable, squirming through the hard-to-watch moments where Fetterman showed the effects of a clinically significant stroke. I had to stop watching because of my discomfort.

The next day, the internet was awash in stories about the debate with most noting concerned about Fetterman’s difficulty speaking and reading during the debate. I was struggling to understand my reaction to the debate and wondering if it reflected an inevitable unconscious bias against people with disabilities.

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As a PA, I work with many patients with disabilities. I take great pride in recognizing the unfairness and injustice of discrimination against people with disabilities and in not defining people by their disabilities. But I started to question what I was feeling while watching the debate. 

Then I saw a tweet that read: “Ableism is rooted in the assumption that disabled people are defined by their disability. Last time I checked, Americans are defined by sharing a commitment to a set of values and beliefs.” The more I read on news sites from the spectrum of politics, the more I saw what the tweeter was talking about. I saw the meanness of so many who mocked Fetterman and laughed at his struggle to speak clearly when he likely needed to do so the most. This led me to think about the mocking of people with disabilities that we see from time to time from politicians, which is the same as we saw (or sadly maybe even participated in or laughed at) as children.

The Oxford English Dictionary defines ableism simply as “discrimination in favor of able-bodied people.” But even that definition causes me to pause. What does “able-bodied” mean? Does it mean perfection, someone who is completely without physical or mental flaws? If that is true, then no human is able-bodied. We all have flaws, physical, mental, emotional, and spiritual. Can someone who has cancer or diabetes or cannot walk be considered able-bodied? Was Franklin D. Roosevelt able-bodied?

Further examination of the Oxford English Dictionary finds that able-bodied is defined as “fit, strong, and healthy; not physically disabled.” All of this gets at some very uncomfortable truths about us as a people and how we think. Even the well-intentioned definition of ableism uses language that demeans people with disabilities. In truth, we are taught as medical providers that disability is not a binary yes or no concept. It is a spectrum on which all humans function. Like gender, science tells us that disability should be viewed as fluid, as changing, and as profoundly humanizing. If you don’t have a disability, then you likely are not a human being.

Words and their meanings and usage matter maybe now more than ever as we PAs, nurse practitioners (NPs), and other medical providers strive to help build a world that is fair and respectful of disabilities that our patients bring to our examination rooms. If we fall victim to the belief that there is an ideal human free of disabilities, then we simply will not be able to do justice to our patients, colleagues, or even ourselves.

So many disabilities do not reflect at all on a person’s character or their ability to think, to reason, or to have insightful and creative thoughts. People with disabilities can lead, make laws, push science where it’s never been before, and think circles around others defined as “able-bodied.”

We know this: while stroke recovery is also a spectrum, millions and millions of our patients recovering from strokes are capable of great things. It’s not just our job as medical providers to help them achieve their goals, it’s also our job to help frame their status in ways that serves to create a more just and fair lens through which the rest of us see, value, support, and encourage them. Let’s help clear the way for patients with disabilities to achieve at levels they may have never even dreamed of.

Postscript: John Fetterman won the Senatorial Race in Pennsylvania 6 months after suffering a severe stroke.