Illness and Citizenship

Contemporary liberal citizenship theory has been repeatedly challenged for the exclusions it reproduces despite its universalist aspirations. These debates have sharpened our understanding of how citizenship is stratified along lines of race, gender, class, disability, and migration status. Yet a pervasive and politically consequential axis remains comparatively under-theorized within mainstream literature: illness. Chronic, recurrent, and identity-transforming illnesses such as cancer, mental illness, or autoimmune conditions do not only affect individual well-being, but they also reshape one’s status as a citizen, in the sense of what they can claim, what they are owed, or how they belong in a given polity. This paper treats illness as a case to question some of the main assumptions on which citizenship theories are built. For instance, theories of citizenship rely on implicit assumptions about the “normal” citizen as healthy and continuously available for productive labor as well as political participation, turning a blind eye to the constant threat of vulnerability faced by all because of the risk of life-altering illness. When those assumptions fail, illness can produce citizenship deficits and injustices across several dimensions, such as insecure access to work and social rights; exposure to stigma and moralized expectations about dependency; medical and administrative gatekeeping that conditions entitlements on compliance; reduced opportunities for participation; and degraded epistemic credibility both within and outside medical encounters. Which are the implications raised by the consideration of such illnesses on citizenship theory? Given that there is not a single theory of citizenship, but several theories of citizenship, the first part of the paper is devoted to an analysis of how liberal, republican, and critical theories of citizenship address illness and qualify the wrongs (i.e exclusions, discriminations, injustices, etc.) affecting individuals and groups. We show that the three theories have blind spots that lead to neglecting some relevant injustices suffered by ill individuals. For instance, liberal theories capture important injustices related to rights, non-discrimination, and equality, but they partially miss how equal legal status coexists with unequal standing produced by stigma, credibility deficits, or care dependency. Republican theory foregrounds civic agency and freedom as non-domination, which helps diagnose how illness can expose citizens to the arbitrary power played by gatekeepers and to forced trade-offs between care, and political voice. However, republican ideals can inadvertently reproduce exclusions if they tacitly treat illness as a deviation from the competent, independent citizen. Lastly, critical theories illuminate how illness becomes a site of biopolitical governance, where belonging is made conditional on self-management and productivity, but they often leave open what principles, or institutional designs, would foster an inclusive model of citizenship in practice. Based on the strength and weaknesses of citizenship theories mapped in the first part, the second part of the paper suggests a structured and integrated framework for illness-inclusive citizenship organized three dimensions of democratic equality: rights and access, relational standing and recognition, and participatory capacity. Such a framework paves the way for a conception of citizenship better suited to address and rectify exclusions from citizenship suffered by ill people.