Smokers Still Potentially Employable

Companies in 21 U.S. states can and do categorically refuse to hire people who smoke tobacco. Leading bioethicists today agreed with a majority of Americans that this is unethical.
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U.S. President Franklin D. Roosevelt smokes a cigarette as he sits on the rocks at Herring Cove on Campobello Island, New Brunswick, Canada on July 30, 1936, where he had a summer home. [AP]

In 2008, the World Health Organization implemented a policy wherein they ask all applicants two questions:

  • Do you smoke or use tobacco products? 
  • If you currently smoke or use tobacco products, would you continue to do so if employed by WHO? 

If the person answers "yes" to both, they "will not be considered for selection."

The WHO justifies the policy:

Tobacco use is the major preventable cause of death in the world, killing nearly 5 million people annually. On current trends, by 2020, around 10 million people a year will die from tobacco-related diseases in developing countries alone, accounting for more deaths than from malaria, maternal conditions and injuries combined. ...  WHO is at the forefront of the global campaign to curb the tobacco epidemic. The Organization has a responsibility to ensure that this is reflected in all its work, including in its recruitment practices and in the image projected by the Organization and its staff members.

The Cleveland Clinic, Geisinger, and other large health systems also have policies against hiring smokers. It goes beyond the health industry, though. Union Pacific Railroad and Scotts Miracle-Gro are among companies of like mind.

In today's New England Journal of Medicine, Drs. Harald Schmidt, Kristin Voigt, and Ezekiel Emanuel (chief of the department of clinical bioethics at the National Institutes of Health) break down some of the rationale:

[A] more general argument is that employees must take personal responsibility for actions that impose financial or other burdens on employers or fellow employees. Accordingly, smokers should be responsible for the consequences of their smoking, such as higher costs for health insurance claims, higher rates of absenteeism, and lower productivity. These costs amount to an estimated additional $4,000 annually for each smoking employee.

Business is business, and $4,000 is $4,000. But as Emanuel et al. go on to say, those kinds of arguments are too simplistic, concluding, "Categorically refusing to hire smokers is unethical." Because smokers are more likely to be at a disadvantaged end of socioeconomic spectra, it puts undue burden on them, in addition to "preempt[ing] interventions that more effectively promote smoking cessation."

The discussion is nuanced and divisive. Drs. David Asch, Ralph Muller, and Kevin Volpp wrote an accompanying commentary in this same issue of the New England Journal that said these policies can be a rational part of imperfect efforts to save lives. They describe these hiring practices as part of a spectrum of Bloombergian deincentivization, the extreme end of which would be outlawing tobacco. In this case, if you don't quit, certain jobs will be unavailable to you. But, again, it's unfair from the perspective that nicotine is one of the most addictive known substances and you're effectively discriminating against people who have a harmful addiction, and are also happen more likely to be poor minorities. Sixty-five percent of Americans agree that this is unethical.

Both perspectives are thoughtful and available in full here and here.

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James Hamblin, MD, is a senior editor at The Atlantic.

 
 
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