(WASHINGTON) — In the Pennsylvania race for a seat in the U.S. Senate, Democratic candidate John Fetterman has had to continuously defend his ability to serve as he recovers from a life-threatening stroke.

“Again, my doctor believes that I’m fit to be serving, and that’s what I believe where I’m standing,” he said on the debate stage Tuesday night, citing a letter from his primary care doctor and declining to commit to releasing medical records.

According to Fetterman’s doctors, the candidate sometimes has difficulty speaking and experiences auditory processing issues five months after his stroke. This prompted criticism and speculation by some about his ability to take on a role in the Senate — however, neurologists have told ABC News that language issues do not indicate cognitive impairment for stroke survivors.

Still, disability advocacy groups say ableism has been continuously thrown at Fetterman throughout his campaign since his stroke by Republican candidate Dr. Mehmet Oz’s team, though the doctor himself has expressed empathy toward Fetterman’s condition.

Ableism refers to discrimination against people with disabilities.

“It’s been, frankly, a distraction,” said Seth Ginsberg, president and co-founder of disability advocacy groups Global Healthy Living Foundation and CreakyJoints.

Ginsberg continued, “We hear daily, from people with chronic diseases that they’ve experienced social prejudice and diminished opportunities based on people’s assumptions about how or what they can or cannot do with their conditions.”

Fetterman’s stroke has played an ongoing role in the political playbook of Oz’s team.

When Fetterman declined to debate Oz in September, Oz’s team released a seemingly mocking list of “concessions” they would make to get Fetterman on the debate stage, including: “We will pay for any additional medical personnel he might need to have on standby.”

After Fetterman’s social media team made fun of Oz for calling a “veggie tray,” “crudité,” Oz’s senior communications advisor Rachel Tripp responded by telling Insider: “If John Fetterman had ever eaten a vegetable in his life, then maybe he wouldn’t have had a major stroke and wouldn’t be in the position of having to lie about it constantly.”

In an interview with NBC News, Oz said he had “tremendous compassion” for what Fetterman is going through.

“Not only do I, as a doctor, appreciate the challenges, but I know his specific ailment, because it’s a specialty area of mine,” said Oz.

He added that he would not speak to a patient the way Tripp had spoken about Fetterman.

However, Oz has criticized Fetterman for not releasing his medical records, saying that voters deserve to know more about the health of a potential incoming politician. When the editorial boards of various news organizations urged both candidates to release their medical records, Oz obliged.

“In the interest of full transparency over my own health, I saw my doctor again to get the most current appraisal of my health status,” said Oz in a statement to City & State PA. “I agree that voters should have full transparency when it comes to the health status of candidates running for office.”

This, and other commentary, has prompted a wave of conversation and speculation about Fetterman’s abilities.

“I was completely ignorant about strokes and stroke recovery – until I had one at age 54,” said Luke Visconti, a chairman of the National Organization on Disability. “Many stroke survivors are able to recover – in my case and apparently with Lt. Governor Fetterman, it takes brutally hard work. People have told me that I’m a nicer person since my stroke. I certainly know I’m more perceptive and empathetic. Don’t we all need more empathy?”

Disabled activists say persistent, ongoing jabs about Fetterman’s condition despite his perseverance on the campaign trail highlight the ways in which ableism turns a condition someone is experiencing into a weapon to be used against them to make assumptions about their abilities.

“We all know Fetterman has this rough-and-tumble, strong, get-things-done persona,” said Sophie Poost, the program director at the advocacy group Disability EmpowHer Network. “He’s adjusting the way he communicates, how he works, how he campaigns, [so] there’s this ablest thinking that says that because these adjustments aren’t ‘normal,’ they’re ‘unnatural.’ Because they aren’t typical to non-disabled people, it’s seen as a weakness.”

In 2021, the Bureau of Labor Statistics found the unemployment rate for disabled people was 10.1% — which is about twice as high as the rate for those without a disability.

“Roughly a third of [Global Healthy Living Foundation] staff has a chronic disease that might otherwise prevent them from holding a job. And, frankly, these people absolutely excel at their jobs,” said Ginsberg.

Fetterman wouldn’t be the first politician to serve with a disability. President Joe Biden has been open about his experiences with speech impediment that causes him to stutter. Texas Gov. Greg Abbott is paralyzed from the waist down. Sen. Tammy Duckworth is a double amputee.

Former President Franklin Delano Roosevelt, who contracted polio in 1921, was paralyzed from the waist down.

According to the National Council on Independent Living, dozens of other politicians with some kind of disability — neurological, physical or otherwise — are currently running for or are currently in office on the federal, state and local level.

“Systems of oppression for individuals who are considered ‘the other,’ be it, disability, race, poverty and gender, need to be actively dismantled,” said Jane Dunhamn, the director of the National Black Disability Coalition. “At the same time when we are dismantling systems of oppression we need more intellectual, cultural and lived-experience humility.”

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