Is It Unethical to Not Hire Smokers?

(Photo: Julie Bocchino)

That is the question asked in a New England Journal of Medicine column by Harald Schmidt, Kristin Voigt, and Ezekiel J. Emanuel:

Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers — a practice opposed by 65% of Americans, according to a 2012 poll by Harris International.

Where do the authors come down?

We agree with those polled, believing that categorically refusing to hire smokers is unethical: it results in a failure to care for people, places an additional burden on already-disadvantaged populations, and preempts interventions that more effectively promote smoking cessation.

But you should read the entire piece; it is clear-headed and interesting throughout. A couple more snippets:

In addition, all other diseases — and many healthful behaviors — also result in additional health care costs. People with cancer burden their fellow workers through higher health care costs and absenteeism. People who engage in risky sports may have accidents or experience trauma routinely and burden coworkers with additional costs. Having babies increases premiums for fellow employees who have none. Many of these costs result from seemingly innocent, everyday lifestyle choices; some choices, such as those regarding diet and exercise, may affect cancer incidence as well as rates of diabetes and heart disease.

And:

Finally, although less than one fifth of Americans currently smoke, rates of tobacco use vary markedly among sociodemographic groups, with higher rates in poorer and less-educated populations. Some 42% of American Indian or Alaska Native adults smoke, but only 8% of Asian women do. Among adults with less than a high school education, 32% are smokers; among college graduates, smoking rates are just over 13%. More than 36% of Americans living below the federal poverty line are smokers, as compared with 22.5% of those with incomes above that level. Crucially, policies against hiring smokers result in a “double whammy” for many unemployed people, among whom smoking rates are nearly 45% (as compared with 28% among Americans with full-time employment). These policies therefore disproportionately and unfairly affect groups that are already burdened by high unemployment rates, poor job prospects, and job insecurity.

It’s also worth reading the comments. Here is one (based on this famous quote), from a physician in Colombia named Mauricio Lema:

First they came for the smokers,
and I didn’t speak out because I wasn’t a smoker.

Then they came for the obese,
and I didn’t speak out because I wasn’t fat.

Then they came for the women in childbearing age,
and I didn’t speak out because I wasn’t a woman.

Then they came for me,
and there was no one left to speak for me.

The word for it when the government does it is fascism. In the business world is just plain [Machiavellianism]. You may get away with it, but don’t disguise it as a stimulus. It stinks worse than tobacco, and it sends the wrong message: that you can bully other people with impunity just because YOU can.

Disclosure: I am obese.


Eric W

Forget the health care costs (which are very real). Lets just focus on what smoking tells an employer.

Smoking is horrible for you. We all know it. So smoking signals to an employer that you don't make good choices in the face of overwhelming evidence. No offense to smokers, but that's not the sort of person I want to hire.

Seminymous Coward

Being unhealthy is not a complete argument against something. There's clearly some degree of unhealthiness and unsafeness that virtually everyone will accept in exchange for enjoyment or fulfillment; see, for example, dessert, sports, and pregnancy. The difference is in probabilities and proportions. That someone else weighs harm and fun differently from you, in general or a specific case, doesn't make their decisions invalid.

More importantly, their decisions shouldn't be subject to your review as an employer at all. Employees' lives outside of work are their own.

Eric W

I take the libertarian sort of view: I'm paying the employee, so I can have any restrictions I want(within the law of course). If I want to say I only hire people who drink Pepsi, I should be able to do that. You don't like my restrictions? Start your own company and work there :) No one is forcing you to work here.

Now obviously, as an employer I'd be excluding people who would otherwise be an asset for the company and I'm potentially annoying customers if they feel my policy is arbitrary or cruel. But that should be MY choice to make. The government should not force me to hire anyone I don't want to.

You as an employee can also make any decision you want. You just have to understand there may be consequences that you don't like. Such is life.

Ben

I'm an almost-graduated law student hunting for jobs. I interviewed with a small firm last week, and in one part of the interview, the partner asked me several inappropriate questions like my age, marital status, etc. He asked if I was on any prescription drugs, and if I smoked. I answered the questions, but told him they were very inappropriate for an interview, and they sounded discriminatory. Whether I smoke (and all the other discriminatory questions) is irrelevant to my ability to practice law effectively. There may be some professions where smoking is a relevant and appropriate discrimination, but I can't think of any. Oh, and I don't smoke.

Mike B

Did you ever think that clients may be turned off by someone who smells like a humidor?

Seminymous Coward

Lots of people are turned off by disabilities, aging, pregnancy, and simple ugliness.

LD

" it results in a failure to care for people, places an additional burden on already-disadvantaged populations, and preempts interventions that more effectively promote smoking cessation."

How is any of that the responsibility of a business?

I like Eric W's comment. It shows poor decision making. Ultimately companies can make decisions they feel are in their best interests (within the law). If they are losing out on good employees because of this policy they will change their practices. But I doubt that's the case.

Seminymous Coward

I'm more concerned with the employer imagining that it's their business whether employees smoke or not. Applications are intrusive enough as it is. Employment contracts shouldn't be a license to pry into private affairs.

LS

Fine, but let's see how many smokers can show up to work not reeking of smoke and then make it all the way from 8 to 5 without ever lighting up, every single day. If you can really do that, no one will even know much less care, but the fact is that most smokers bring their smoking into the workplace.

Kelly

@LS I have showed up to work all my (working) life not smelling like smoke and working 12 HOUR shifts with no smoking....and I'm a smoker. Almost every person I have worked for or with never knew I even smoked UNLESS they saw me doing it.

Ashley R

I'm surprised they don't mention smoke breaks. Does the average smoker work as much of the 40 hour week compared to a non-smoker?

Astraea

Federal law requires breaks, and most smokers are capable of restricting themselves to smoking when they have their federally mandated breaks.

Rex W.

Yes, but human behavior takes over and, breaks carry a value.

I, first hand, experienced a case in which a department (emergency room) manager was a smoker, allowed fellow smokers additional breaks and, as a result a non-smoker took up smoking in order to "justify" the additional breaks.

Craig

Instead of going after smokers, why don't employeers go after the health care industry? Health care costs are high because of fraudulent behavior on the part of the health care industry, not because of risky patient behavior.

For instance. I had a sleep study that was quoted to me at $1700. Although I had no extraordinary procedures or problems, the clinic charged my insurance company $4200+. Then when I called to complain, they told me they would never charge me more then I was quoted. So they wiped the $2000 my insurance company slated as patient responsibility. But they kept the other $2200 ($500 more then they quoted me) they got from the insurance company.

And now they're trying to pin it on us so they can keep their greed driven fraud going? Bull crap! I never though I'd say this, but socialism is beginning to look a hell of a lot more attractive then out of control selfishness and greed.

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Eric M. Jones

Would you hire a crackhead or a junkie? Well, smokers are junkies. They waste YOUR time and money on their addiction.

Craig

Maybe they otta stop hiring caffeine addicts as well.

Rex W.

Then nothing would ever get done!

Mike B

The line between permissible and impermissible discrimination lays with the role of personal choice. Some things like race, gender, sexual preference, nationality and a large number of healthcare issues, are determined by birth and should not be basis for discrimination in areas like employment. However things like smoking, drug use, alcohol use, weight and other lifestyle choices are exactly that....CHOICES and people need to be held responsible for their choices. Yes some actions are addictive and can reduce the role of choice, however nobody forced someone to start smoking or using addictive drugs and addiction may be hard to break, but it isn't impossible.

On a more practical node in the case of smoking, which is simply a subset of drug use, if someone cannot overcome their addiction in order to stop smoking how can they be relied on to overcome their addiction enough to adhere to company policies on smoking like not smoking on the job? In that case the person is no longer a threat to themselves, but now could bring their personal problems into the workplace.

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Dave

Not to get too political but was a gay gene discovered? Why is it a forgone conclusion that people are born gay? The proclivity to be attracted to the same sex may exist but more than likely it's a combination of nature and nurture that leads to homosexuality.

Also, is it not a lifestyle choice to indulge in it?

Lastly, you listed "alcohol use" in what they should be able to discriminate on. Should we discriminate on alcoholism which can be hereditary?

Pshrnk

No one has to take that first drink. Maybe Mitt Romney has a genetic predisposition to alcoholism or other addiction, but his lifestyle prevented that from ever being a problem. No matter your genetics you do have a choice.

EQ Test

Spot the fascists^^ If smokers are such a burden maybe w should just gas them all??

Michael

It's unethical for publicly funded workplaces to discriminate against people for damn near anything. But private businesses should be able to hire/fire or accept people as customers based on whatever the owner feels like. This often isn't the most rational thing to do, and people can certainly protest you and that'll also hurt your business, but part of being the owner is being able to make your own decisions. My property is my own to use or misuse.

J1

1. It's not unethical; smokers are drug addicts, and that addiction will inevitably come before their job at some point(s).
2. It's nothing new. I've been with my employer 25 years. At least in my specific job category, in that time I have never come across or heard of a new hire who smoked. I should note that in my business, smoking is an issue because of situations in which smoking violates the law, and we can go for extended periods of time (as much as 16-18 hours) during which it's not physically possible for a smoker to move to an area where it is legal. I know some extremely senior people who smoke (and are able to avoid the situations I described above), but the unstated policy for at least 2+ decades has been no smokers.
3. While there are risks in the activities listed in the third "snippet", there's a difference between an activity that involves some risk and an activity that is effectively certain to cause health problems.
4. While the ADA prohibits discrimination on the basis of disability or (AFAIK) health conditions in general, it does permit an employer to require a pre-employment physical and/or drug testing. I'm pretty sure the latter can identify a smoker, and positive the former can.

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NG

I recently came across this same question when my parents, owners of a small mom & pop restaurant, were looking to hire a waiter/waitress. First concern for them was that he/she not smoke. My instinct was to tell them that they could not outwardly discriminate like that, but I can't say I don't agree with their thought.

In addition to the general "bad decision making" comments listed above, their concerns were that a smoker will inevitably smell like smoke when serving customers, will request multiple breaks to smoke (above that required by law), and the general health issues that could affect their working ability or presentation to the guest.

Laurie Mann

When workplaces went non-smoking in many areas in the early '90s, I thought that was great, but we then didn't turn around and fire smokers (or fat people like me, or motorcycle riders or gun owners or...) for their bad habits. Many people who have bad habits are still good employees. I think not hiring people because they smoke is insane.

Phil

"Although less than one fifth of Americans currently smoke... for many unemployed people, among whom smoking rates are nearly 45% (as compared with 28% among Americans with full-time employment)"

That would imply that the lowest rates of smoking are associated with part-time employment. This is either an error or an intentional omission because it doesn't support the main point.

delocalizer

There is no error or omission implied here as the samples of population being considered are not the same.
I think you assume the weighted full-time/part-time/un/employed smoking percentages must sum to the total figure of "less than one fifth" — this is not correct as the total proportion of people categorized as either employed (full-time or part-time) or unemployed (of working age, actively seeking work) is much smaller than 100%. Intuitively, people of working age are more likely to smoke than the population as a whole.

Enotional Quotient

Surprising! 61% of population disagree yet freakonomics followers seem overwhelmingly fascist!? I work like a dog, study hard, and have an IQ of over 130 yet most of you would write me off before giving me a chance. Maybe it's just the non-smokers chamce here to show their high and mightyness here that appears to thats contradict public opinion.

J1

Not wanting to hire smokers really doesn't have a component of rigid economic control or ethnic nationalism I'm aware of, so you'll need to elaborate on the fascism business.

Steve

Yet another reason why health insurance needs to be decoupled from employment.

Daryle

It's not a question I'd ever answer in an interview. It wouldn't affect my ability to do the job, and it indicates to me that the employer doing the interviewing isn't attempting to hire the best people available to work for them. Everything else is irrelevant, and an excuse for lazy hiring processes.

Rex W.

What a timely series of articles as our health systems is currently in debate over enacting this very policy - no longer hiring tobacco users.
We have clear data (not that we need it, we all know it regardless) showing how much more our employees who are tobacco users cost our health plan. We also have the best understanding and most data overall regarding the harmful affects of tobacco use. And, as a health care system (largest in our state) we have a commitment to aide in the improvement of the health and wellness of the communities we serve. We (health care systems & providers) shouldn't support tobacco use in any way and, by not hiring tobacco users that is a statement of where we stand. There are companies that have not only gone the route of not hiring but have also eliminated all tobacco users from the organization (after a long process to provide support to those who want to comply and quit).
I understand the argument for those of lower socioeconomic status and the disproportionate impact but, the other side of that argument is this - think how much they would save each year if they didn't smoke!!!! Easily over $1,000 per year would be saved!

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Astraea

If you are basing your decision on healthcare costs, you should also refuse to hire women of reproductive age (babies are expensive!), and African-Americans (generally more issues with high blood pressure, diabetes, and asthma). You can't do that because it's horrible discrimination? Yeah.

BartF

I admit that I am shocked. Shocked that Dubner would come down against the free market, and in particular, would proselytize in favor of a particular brand of ethics over another. Let me elaborate.

In the semiconductor industry, it' s a well-accepted rule that smokers who work in clean rooms lower chip yields by a significant percentage, even if they aren't smoking at the time. Is it more ethical to pay a smoker the same wage as a non-smoker, even if that hurts the widows and pensioners who rely on that company's stock dividends for income? Is it unethical to refuse to beat a masochist? To feed a vampire with your blood to avoid letting him starve?

It's not unreasonable to think that truckers who smoke have more accidents. If so, what about the accidents that kill innocent motorists because Dubner decided that trucking companies needed to hire smokers? Or is this simply the cost borne by society for embracing "tolerance?"

In Birmingham recently, a large airport sign fell onto a family, killing at least one. Early reports say it was shoddily installed. What if it could be proven that this was due to negligence of a smoker who took his cigarette break in a nicotine fit, rather than ensure that the sign was properly installed? Or, more likely, what if a systematic study using randomized trials demonstrated conclusively that smokers are significantly more likely to cause such accidents? What does the "ethics meter" tell you there? Should the family sacrifice its child to the gods of smoking-blind hiring practices?

What if, instead, there were two markets for labor, just as there is with insurance? Smokers would in many jobs be paid less, based on their expected lower productivity, etc. This might in fact have some positive societal benefits, to wit:

- smokers would see clearly the total cost of their habit; this might help convince them to quit. Think of Vroom's expectancy theory model, where what Vroom called their Instrumentality (belief that successful performance will lead to a reward) goes up dramatically, as does their Valence (value placed on that reward)
- companies might develop technology to counter the deleterious effects of poor-performing smokers (e.g. better filtration in clean rooms); these companies would be rewarded with a cost advantage over their competitors
- Smokers would have more options. Despite what smokers think, most non-smokers can tell a smoker just by standing next to them in the elevator. It's therefore impossible to enforce a ban on smoking discrimination- it never needs to be mentioned. But if they come clean (so to speak) about their habit, they get to be hired at the "discount" rate. The labor market for smokers would clear, or come closer thereto.

That whine from Mauricio Lema is silly; this is plain capitalism, which is exactly the opposite of fascism.

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ERLW

"Despite what smokers think, most non-smokers can tell a smoker just by standing next to them in the elevator."

Other than a follow-up survey, how could you possible know this? I agree that if they smell like a smoker, then they're probably a smoker... but if they don't smell like a smoker, what does that prove?

Also might it also be true that truckers who smoke are so vigilant about being even seen to lose control that the drive extra carefully? Not that I necessarily believe that, but without data it is just a conjecture much like your statement above.

BartF

The link to the data is below: per the NIH, smokers have a 50% greater chance of accidents.

http://www.ncbi.nlm.nih.gov/pubmed/2331646

The "drive extra carefully" argument is one I made in my teens about drinking and driving. Doubtless, no one over the age of 22 actually buys it.

Cary S.

I'm a non-smoker and an electrician. During my career, I've encountered my fair share of smokers who seem like they have the /right/ to smoke. They'll stop every couple of hours for twenty minutes or more. I keep working while they stop for yet another break.

As a non-smoker, it's annoying as crap. I'm working, they aren't. However, if I ALSO stop working, I'm reprimanded.