The Brisker Rav said in the name of his father, R. Chaim Soloveitchik, that when חז"ל established the four fasts, they did not create a fast-day obligation and then exempt a חולה (someone who is ill). Rather, the fasts were instituted only for healthy individuals. A חולה was never included in the original תקנה.
Therefore, a חולה has no reason to be מחמיר and fast.
Even if he chooses to fast, it is not considered a halachic fast, since the obligation never applied to him in the first place.
Some Poskim add that according to R. Chaim's understanding, if several חולים are needed to complete a מנין, it may be questionable whether ויחל should be read.
Since the original תקנה of the fast never applied to them, there may technically not be a מנין of Jews who are halachically participating in the fast—even if all ten are actually fasting.
Mori V'rabi, Harav Hagaon R. Shlomo Miller שליט"א remarked humorously that perhaps this creates yet another Brisker chumra:
Not to give an עלייה on a fast day to anyone who might be a חולה.
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