In the past week, I have received ads that are relevant to me based on what I’ve searched for on Google, based on items that I’ve viewed on Amazon, based on a database’s specific understanding of my age, geographic location, income, and family status, and based on my browsing history. If I wanted to, I could target you right now with a digital experience based on the car you currently drive, the beer you likely drink, or whether or not you’ve ever been to Des Moines. It is neither difficult nor expensive to do it. We live in the age of personalization; targeting is the rule, not the exception.
Unless that is, you are among the 1-in-5 Americans who have a disability. While there are mechanisms to target consumers with experiences based on whether they are physically disabled or mobility impaired, they rarely see use. On the face of it, that feels appropriate. Indeed, just the words “targeting by disability” invokes a headspace that is, best case, reminiscent of grade-school bullying and, worst case, full-on dystopian. The question implicates strong reactions, and rightfully so. 
On the one hand, medical data, even anonymized or inferred medical data, is among the most private that exists. Using that information to market goods and services feels like a violation of privacy if not simply intuitively gross. On the other hand, people with disabilities are currently so marginalized as to be almost non-existent in contemporary media, including advertising. Data is difficult to come by on this topic, but one study by Lloyds Banking Group in 2016 found that people with disabilities were present in .06 percent of ads, despite being 17% of the population at large in the UK. Six out of 10,000 ads had a person with a visible disability in them. 
For an industry that presumes to put the consumer at the center of everything, we are literally excluding the 1/5 of the population who has a disability by failing to create segments that cater to their specific user journeys. Which begs the question: Do we have an obligation to ignore known or likely disabilities as we market to consumers or do we, in fact, have an obligation to actively invoke that aspect of targeting and personalization?
Isn’t targeting based on medical diagnosis illegal? 

If you are a medical caregiver, your ability to market using data collected from your patients is likely constrained by laws such as HIPAA. Outside of that, there are little more than recommendations and guidelines. The NAI Code of Conduct distinguishes between sensitive and non-sensitive medical data with respect to ad targeting but are not exhaustive on where specific disabilities fall. 
HIV status, as one example, is an explicit example of a condition that is expressly sensitive and should not be segmented. Being a partial amputee, however, is not, and it is left to the marketer to determine appropriateness based on a number of qualifiers, including the prevalence of the condition in society and whether an average person would deem the disability private. It is a thoughtful, if potentially ambiguous, set of principles that allows brands to explore the option to segment in many cases.  
Even if legal, targeting for disability in marketing is inherently too sensitive 
Too sensitive for whom? On Facebook, I can target you based on whether you are pregnant, but not if you’re wheelchair bound or if you have a child whose upper limb loss makes tying shoes difficult. The unstated difference between those scenarios is that the former is historically heralded by society as a blessing while the latter are stigmatized as a curse. Any view of a disability as “too awkward to broach” in the context of advertising is a problem purely on the part of the advertiser and is increasingly at odds with how members of the disabled community have viewed themselves over recent decades.  
What if we come off as tone deaf or inappropriate? 

Sending out a frivolous, inauthentic, creepy, or downright stereotypical targeted ad is a pitfall we face as marketers, regardless of audience (just ask Pepsi or Bic). As for any targeted advertising, we must ensure that the content provides benefit to the customer, that we present it appropriately both in form and context, and that the message is persuasive. 
Do you know what the best way to guarantee your content is appropriate for the disabled community? Hire a diverse and inclusive marketing team, specifically including marketers with disabilities, and give them the space to make the right decisions. Having members of your team who are impacted by disability will also help prevent the pendulum from swinging too far in the other direction — targeting disabled consumers so much that we fail to look at them as anything but the vessels of their disability. If we target exclusively on whether someone is in a wheelchair, and not (also) whether they have a family, and take beach vacations, and like dark chocolate, then we are contributing to a perpetuation of the stereotype rather than to its solution.
Targeting based on disability may have some real benefits for the consumer-brand relationship as well. For one, it proves to the consumer that the company has consumers with disabilities in mind both when designing products and when considering motivations for purchase. Rather than displaying a product being used by a typical model that a person with disabilities could, with some ingenuity, adapt to serve their own needs, a targeted ad would demonstrate that the consumer with a disability is the typical consumer considered at the outset. This inclusivity and consideration as a primary audience are central to dissolving our society’s historical focus on people with disabilities as an “other,” and might even lead the way for other industries, such as entertainment, to act similarly. 
From the people we use in the ads we create to the scenarios we put those people in to convey a “universal truth,” the advertising industry has long rested on assumptions that people with disabilities and those who care for them represent corner cases. That’s a self-fulfilling prophecy, and one that risks obstructing de-stigmatization. 
To be on the right side of this, advertisers need to include a more truthful, representative set of targeted user journeys in our marketing both at a global level and at an individual level. If we properly and intentionally use the power of targeted marketing on behalf of our disabled customers, beyond simple color preference or past purchase, we might drive real value for an audience we’ve ignored for too long.