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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.