Smokers Need Not Apply
While tobacco use is the leading cause of preventable death in the United States, the country has undergone a substantial cultural shift in regard to smoking [1]. Due to recent changes such as the banning of cigarette vending machines, the creation of no smoking policies, and increased education about the health impacts of tobacco use, the prevalence of smoking has decreased substantially. The Centers for Disease Control and Prevention estimate that smoking-related medical care costs $170 billion dollars annually [2]. In the interests of employee productivity, as well as saving on the cost of employees’ health insurance, some employers will no longer hire smokers [3]. Hospitals in particular have taken the lead in adopting such policies, but they are not the only employers making this change. Some states have laws that prohibit this kind of discrimination against smokers in hiring but many others do not [4].
While the prevalence of smoking has declined, it has not done so evenly across groups. Prevalence is higher than average among non-Hispanic multiple race individuals, American Indians/Alaska Natives, and Blacks. Prevalence is also higher among populations with low socioeconomic status, within the LGBTQ community, and among those who have not graduated high school or who have a GED [5].
As mentioned above, supporters of anti-tobacco employment policies cite both health insurance costs as well as employee productivity as important factors. In addition, healthcare professions and healthcare settings note that healthcare workers who smoke are setting a terrible example and sending a very bad message to patients. Advocates also argue that such policies create an incentive for prospective employees to quit smoking.
Detractors point out that policies that exclude employees who smoke infringe on employee freedom by dictating their behavior even when they are not at work. Moreover, to the extent that smoking is addictive and difficult to quit, these policies punish smokers for their addiction no matter their efforts to stop smoking. Another worry is that these policies have a disproportionately negative impact on poor and disadvantaged populations. This exclusion is especially worrisome given that many of these populations already struggle with employment discrimination and are already underrepresented in many professions, including those in healthcare settings.
DISCUSSION QUESTIONS
Is there a morally significant difference between anti-tobacco employment policies in a healthcare setting as contrasted with other kinds of employment?
When, if ever, is it morally permissible for employers to discriminate on the basis of tobacco use? Is it morally permissible to exclude applicants that engage in other health risk behaviors, such as eating unhealthy foods or drinking alcohol?
When and to what extent should employers be allowed to exert control over employees’ lives?
References
[1] NPR, “CDC Report Reveals Decline In American Smokers”
[2] Centers for Disease Control and Prevention, “Smoking & Tobacco Use: Data and Statistics”
[3] The New York Times, “Hospitals Shift Smoking Bans to Smoker Ban”
[4] Workplace Fairness, “Smoking and the Workplace”
[5] Centers for Disease Control and Prevention, “Smoking & Tobacco Use: Adult Data”
