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.


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.


"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.

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.


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


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!



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.


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.


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.