Illness as Differentiated Citizenship: A Conceptual and Theoretical Exploration

Contemporary liberal citizenship theory has witnessed a breadth of criticism over the course of the last decades, particularly with regards to how exclusive its theoretical premises are with regards to a variety of marginalized citizens, jeopardizing their promised ideal of universal status. A great conceptual absentee in the conversation about the potential internal exclusions of citizenship theory is the topic of health and particularly illness. Individuals suffering from illness, especially those of the chronic and identity-transforming kinds (such as cancer or AIDS amongst others) are faced with immense challenges with regards to their social and political rights in a variety of public spheres, for instance discrimination at work and in hiring processes, poor political representativity, tainted relationships due to various forms of stigma, as well as overall diminished agency and degraded epistemic credibility. All these dimensions pertain to different aspects of contemporary citizenship theory and pose difficult questions with regards to the equal moral status of ill persons when compared with that of healthy citizens. This paper seeks to address this gap in a two-fold manner. First, through a conceptual and theoretical exploration, we show that current theories have an implicit bias that favors healthy citizens over their ill counterparts, thus risking creating a social and political underclass of ill citizens. Secondly, inspired by current bioethical research on the matter, we attempt to lay a normative foundation for further work in this area, highlighting the different routes citizenship theory can take in ensuring the proper political inclusion and recognition of ill persons as active citizens and not merely passive subjects impaired by their health condition.