What Voters Can and Can’t Learn from John Fetterman’s Stroke

Health is rarely the thing that differentiates a competent politician from an incompetent one.

 By Dhruv Khullar

October 24, 2022

In mid-May, four days before the battleground state of Pennsylvania held its primary election, John Fetterman, the state’s lieutenant governor and the Democratic front-runner for a pivotal U.S. Senate seat, was on his way to a campaign event. In the car, his wife noticed the left side of his face drooping and his words starting to slur. She insisted, despite Fetterman’sobjections, that they reroute to a nearby hospital; there, doctors introduced a catheter into his groin, snaked the device to his brain, and retrieved the blood clot that had caused a stroke. From his hospital room, Fetterman easily won the Democratic nomination, which pits him against Mehmet Oz, the celebrity doctor turned G.O.P 

politician, in the general election. That same day, he underwent a two-and-a-half-hour procedure to implant a pacemaker and defibrillator in his chest.

 Strokes can be devastating. Fetterman is fortunate to have survived and, it seems, mostly recovered. But, as any first-year medical student can tell you, “time is brain”: even brief lapses in the flow of oxygen to neurologic tissue can have lasting consequences. Fetterman spent nine days in the hospital and three months off the campaign trail. Since returning, his speech is less fluent; at times, he has difficulty finding the right word, or pronouncing it once he’s found it. He struggles with auditory processing, or reliably comprehending spoken language, and has used closed-captioning for interviews and campaign events. “I sometimes will hear things in a way that’s not perfectly clear,” Fetterman told Dasha Burns, of NBC News, during his first in-person television interview since the stroke. During the conversation, which aired on October 11th, real-time captioning helped Fetterman read and respond to questions. But Burns later said that she wasn’t sure Fetterman had followed her small talk beforehand. (Other journalists have taken issue with this characterization, saying that Fetterman didn’t have trouble during interviews with them.) His health has continued to draw attention as he prepares to debate Oz in Harrisburg, Pennsylvania, on October 25th.

 lthough millions of people use closed-captioning, and Fetterman’s reliance on it does not signify a general cognitive decline, any serious neurologic event inevitably raises concerns about whether a candidate can perform the duties of office. Such concerns can be legitimate: a senator’s job is among the most demanding and influential in the country, and voters deserve a clear understanding of whether a person can competently represent them. But politicians’ medical histories are also easily misused. After the NBC interview, a Twitter account managed by the Republican National Committee shared a montage of Fetterman’s verbal stumbles and asked, “Does it sound like John Fetterman is fit for office?” The next day, Tucker Carlson asked on Fox News, “Where exactly does the software end and John Fetterman’s consciousness begin?” Oz’s senior communications adviser said that Fetterman might not have had a stroke if he’d “ever eaten a vegetable in his life,” and his campaign suggested that Fetterman had trouble standing. Oz himself has said that he would not talk to patients in the way his campaign has talked about Fetterman, and that the people who speak for him don’t necessarily speak for him.

 

 These attacks are troubling not because a candidate’s health should be off-limits but because health status is almost never the thing that differentiates a competent politician from an incompetent one. Not only does this type of health information have limited predictive power—a candidate’s comportment during the rigors of a campaign may prove far more revealing—but it’s also vulnerable to a kind of medical misdirection that foregrounds stereotypes about disability and seeds doubt or bias in the minds of voters.

 

 Fetterman’s stroke was caused by atrial fibrillation, a type of irregular heart rhythm that he has experienced for at least five years, and for which, by his own admission, he stopped taking medication. His campaign has released a number of documents related to his condition: according to a June letter from his cardiologist, he also has a previously undisclosed condition called cardiomyopathy, meaning that his heart isn’t pumping at full strength. The letter didn’t specify its severity, but the placement of a defibrillator suggests that it is serious, as these devices are typically implanted when a key marker of heart function decreases by about half. Fetterman has said that, come January, when the new Congress takes office, he will be “a lot better.” Most functional improvement occurs up to a year after a stroke, so this is a realistic hope, but far from assured: he may improve further; he may not.

 

 In the meantime, his campaign’s medical messaging has been spotty. Last month, his campaign said that he scored well on two cognitive tests, but released the results of just one, a move that could uncharitably be compared to a student submitting a partial college transcript listing only the classes in which he excelled. His campaign also said that “John does not have aphasia,” though this is the term most doctors would use to describe his difficulties understanding and expressing spoken words. Assuaging the public’s concerns doesn’t require wholesale release of medical records so that partisans can dissect every lab test, imaging study, and bowel movement. But his campaign should transparently present data about his deficits and recovery, offer regular updates from his doctors, and describe the accommodations that he would need if he’s elected. Last week, after refusing repeated requests for an up-to-date medical assessment, Fetterman posted a note from his primary-care physician, which described communication improvements and said that he has “no work restrictions and can work full duty in public office.”

 

Each of the conditions affecting Fetterman also affect millions of Americans, and they can be managed, often with little impact on one’s ability to travel, socialize, and work. (Just this year, Senators Christopher Van Hollen and Ben Ray Luján suffered strokes; both are back at work.) In recent weeks, Fetterman has held rallies,  spoken at town halls, met with editorial boards, and accepted live-interview requests. Fetterman’s ability to read and respond to written language also suggests that his cognitive capacities haven’t been meaningfully compromised. In a way, then, the continued questions about Fetterman’s health seem to ignore the ample evidence that he is already carrying out a demanding job, and may reflect a bias on the part of the media and the electorate to focus on the new and dramatic. In response to Fetterman’s use of closed captions, Ed O’Keefe, of CBS News, wondered whether Pennsylvanians will “be comfortable with someone representing them who had to conduct a TV interview this way?” But suppose Fetterman was congenitally deaf and relied on closed-captioning all the time. Why would that be disqualifying?

 

 The usual argument for probing candidates’ medical histories rests on a reasonable question: Can they perform the duties of elected office for the duration of their term? Unfortunately, medicine rarely offers satisfying answers to this question. Beyond serious cognitive deficits—the inability to comprehend, manipulate, and convey complex information, for instance—few medical conditions should prevent one from serving in office, and every effort should be made to support those who need assistance. Meanwhile, the course of an individual’s illness is notoriously difficult to predict, subject to conjecture and bias. (Studies suggest, for example, that the better physicians know patients, the less accurate they are in their prognoses.) In general, age is the strongest predictor of whether one’s health will decline and, judging by the average age of U.S. senators, sixty-four, Americans have no problem accepting such risks. (The average American is about thirty-eight.) Some of the nation’s most venerated political figures—Kennedy, Roosevelt, Lincoln—struggled with serious physical or mental-health conditions. Fitness for office, then, is more a political judgment than a medical assessment. A candidate’s performance during the campaign may be the best measure of how competently we can expect them to serve.

 

 Ableism is a curious kind of bias, considering that nearly a third of the American electorate has a disability or lives with someone who does. It’s a form of prejudice that, in the end, we’re all at risk of experiencing, irrespective of race, gender, or political affiliation, simply by virtue of being human. Still, it seems to afflict our body politic. People with disabilities are underrepresented in politics: only six per cent of federal elected officials have one, according to a recent study by Rutgers University researchers. A person who needs assistance is often seen as less able to perform the duties of representative government than, say, someone who lies about his record, peddles unproven remedies, encourages political violence, or tramples on democratic norms. There are many reasons that a person could prove unfit for office. Few have to do with their health. ♦