WASHINGTON — When John Fetterman, the Democratic candidate for Senate in Pennsylvania, faces his Republican opponent in a high-stakes debate on Tuesday night, he will face twin challenges: making the case for his policies while convincing voters he is healthy enough to serve.
The debate, the first and only in a race that could determine whether Democrats keep control of the Senate, will look different than any other. Two 70-inch monitors above the heads of the moderators — scrolling the text of their questions, as well as transcribing the answers, attacks and ripostes of the Republican, Dr. Mehmet Oz — will be visible to TV watchers whenever a camera pans to the moderators.
Mr. Fetterman, Pennsylvania’s lieutenant governor, needs the accommodations because the stroke he had in May left him with an auditory processing disorder, a condition that affects the brain’s ability to filter and interpret sounds, his primary care doctor said last week. He uses closed captioning to follow conversations. Sometimes his speech is halting. Sometimes he stumbles over his words. But he has “no work restrictions,” the doctor said.
Democrats say this makes him seem relatable. Disability rights activists say Mr. Fetterman has been a victim of prejudice from Republicans and reporters who focus more on his health than the issues. But Mr. Fetterman — who also has a heart condition that his cardiologist says was exacerbated by his failure to seek care and take medicine — was cagey about answering health questions in the early months of his campaign, which has left him open to bipartisan criticism about a lack of transparency.
“He handled the issue badly at first because he was evasive for months, and that’s changed,” said Shanin Specter, a politically active Philadelphia lawyer (and the son of former Senator Arlen Specter of Pennsylvania), who said he is not supporting either candidate. “He should be more worried about the electorate’s concerns about his evasion than about his capacity.”
The race pits Mr. Fetterman, a tall, tattooed figure who favors hoodies and shorts and casts himself as a working man, against Dr. Oz, a former TV celebrity — and newcomer to Pennsylvania residency — who was scolded by senators in 2014 for using his TV show to promote foods and dietary supplements that falsely promised weight loss. Dr. Oz has been endorsed by former President Donald J. Trump, who has said his long television run was proof of his political viability.
The general election contest has tightened in recent days, as once-skeptical Republican voters fall in line with Dr. Oz. Polls show Mr. Fetterman’s solid lead has nearly vanished this month.
The Oz campaign spent months taunting and openly mocking Mr. Fetterman as mentally unfit to hold office. But now, amid a social media backlash from some voters as well as disability rights activists, Dr. Oz and his allies are shifting course. They have insisted the debate will be about policies, not health.
“I don’t think that viewers are tuning into this debate to learn about John Fetterman’s health status,” said Barney Keller, a senior strategist for Dr. Oz. “I think they’ll tune into the debate to learn about the contrast between the candidates on the issues.”
Mr. Fetterman has long sought to turn the Oz campaign’s attacks on his health to his advantage. “Recovering from a stroke in public isn’t easy,” he recently wrote on Twitter. “But in January, I’m going to be much better — and Dr. Oz will still be a fraud.”
Still, Democrats worry that any off-key moment by Mr. Fetterman could go viral and affect the outcome of the race.
“We are prepared for Oz’s allies and right-wing media to circulate malicious viral videos after the debate that try to paint John in a negative light because of awkward pauses, missing some words, and mushing other words together,” Rebecca Katz, Mr. Fetterman’s senior communications adviser, and Brendan McPhillips, his campaign manager, wrote in a memo on Monday.
Although Mr. Fetterman has sat for one-on-one interviews with news outlets using closed captioning, the debate will move much faster — with cross-talk and interruptions — and it is unclear how the technology that Mr. Fetterman relies on will keep up, and how he will respond.
His auditory processing issues mean that he typically avoids situations when voices and noise come from multiple directions. He has held no free-for-all meetings with voters or a gaggle of reporters.
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Ahead of the debate, the Fetterman campaign sought to lower expectations. “John is five months post-stroke and Oz has spent the last two decades literally in a TV studio; if there’s a home-field advantage, it’s definitely his,’’ said Ms. Katz, who is overseeing his debate preparations.
In an earlier debate during the Democratic primary race that predated Mr. Fetterman’s stroke, he was considered the least verbally dexterous of the three candidates, though he went on to win the nomination easily.
“Please remember that John did not get where he is by winning debates, or being a polished speaker,” Ms. Katz said. “He got here because he connects with Pennsylvanians.”
Mr. Fetterman, who had a stroke days before the Democratic primary in May, later had a pacemaker and defibrillator implanted to address atrial fibrillation — an irregular heart rhythm — which was the underlying cause of the stroke. In June, the campaign released a statement from Mr. Fetterman’s cardiologist, Dr. Ramesh R. Chandra, that said the candidate also has cardiomyopathy, a weakened heart muscle.
In a letter released last week, Mr. Fetterman’s primary care doctor, Dr. Clifford Chen, said he is “recovering well” from his stroke. He is continuing to get speech therapy, which experts say is standard treatment for an auditory processing disorder. Experts also say such disorders often improve with time, and do not render a person unable to hold public office.
Research shows that people who have had strokes improve more rapidly in the beginning, said Dr. Clinton Wright, director of the division of clinical research at the National Institute of Neurological Disorders and Stroke. But Mr. Wright said the data show that patients can continue to improve a year after the stroke.
“This is a teachable moment,” said Jean Hall, director of the Institute for Health and Disability Policy Studies at the University of Kansas. “My question would be, What if his stroke had resulted in him being deaf and he needed a sign language interpreter?”
Medical experts say that is an apt comparison, though auditory processing disorders have nothing to do with hearing. Rather, people with such disorders have a hard time processing small sound differences in words, because their brains don’t hear sounds in the usual way. Closed captioning makes conversations easier to follow.
“Auditory processing has nothing to do with a person’s intelligence or the ideas in their head or their thoughts,” said Dr. Peter Turkeltaub, a neurologist and director of the Cognitive Recovery Lab at Georgetown University Medical Center. “It’s just the input and output: Can you connect those ideas to the words you are hearing, and then can you take the ideas and connect them to your own words?”
People with disabilities have long held public office. Franklin D. Roosevelt used a wheelchair, although he tried to hide it from the public. Gov. Greg Abbott of Texas, Senator Tammy Duckworth of Illinois and Representative Jim Langevin of Rhode Island also use wheelchairs.
But visible physical limitations are easier to explain to voters, said Lisa Iezzoni, a professor at Harvard Medical School who researches health disparities on people with disabilities. Because voters can’t clearly see Mr. Fetterman’s disability, however, he must fight “this perception that his mind was altered in some way.”
In Mr. Fetterman’s first live television interview since his stroke, which was broadcast on Oct. 11 by NBC News, the reporter Dasha Burns told viewers that before the formal interview, Mr. Fetterman seemed not to follow her attempts at small talk without his monitor.
“Quite frankly, it really infuriated me,” said Judy Heumann, a longtime leader in the disability rights movement, who helped pass the Americans With Disabilities Act in 1990 and later served in both the Clinton and Obama administrations. “Voters should be looking at what he’s doing and what he’s saying, and not whether he uses a communications device.”
Over the weekend, Dr. Oz steered the conversation away from Mr. Fetterman’s health toward his policies. “I just want him to show up on Tuesday so we can talk to Pennsylvania about our policies, and let them see how extreme his positions have been,” he told Fox News.
The Fetterman campaign believes that Dr. Oz and his allies in the right-wing news media went too far in calling attention for months to Mr. Fetterman’s sometimes halting speech and fumbling for words. They say it might work to Mr. Fetterman’s advantage, by lowering expectations for his performance.
“Even if he stumbles on a few words here and there, I don’t think it’s a big deal to voters,” said Mike Mikus, a Democratic strategist. “There’s a lot more opportunity than risk for John Fetterman in this debate.”
Dr. Iezzoni, the Harvard professor, said the debate would be a referendum on voters as well. The World Health Organization, she said, has described having a disability as a “universal human experience.” Seeing Mr. Fetterman use closed captioning — and answer questions in a halting, not necessarily fluent way — will test the public’s tolerance for differences, she said.
“It will be interesting to know whether the public has empathy for human frailty, which we all experience in some way or another,” she said. “Will they be willing to look past it or do they demand perfection?”
Katie Glueck contributed reporting.
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