The Issue
Twenty-nine U.S. states have laws prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many employers in those 21 states including a large number of health care organizations have instituted policies that ban the hiring of smokers, despite a recent poll showing 65 percent of Americans oppose the practice. In a new Perspective in the Journal of the American Medical Association, former Commonwealth Fund Harkness Fellow Harald Schmidt and coauthors argue that refusing to hire people who smoke is unethical.
What the Study Found
The authors identify two main arguments made in favor of banning smokers as employees: 1) in health care organizations, it helps denormalize tobacco use among workers, thus enabling them to serve as role models for patients; and 2) more generally, employees must take personal responsibility for actions that place financial and other burdens on employers and coworkers. The authors point out that the first argument is callous and contradictory institutions that care for patients regardless of illness should not refuse to employ smokers. The second argument ignores the fact that smoking is addictive and therefore not completely voluntary and that smoking is encouraged by cigarette companies.
Moreover, cancer and other chronic diseases, as well as pregnancy, participation in risky sports, and countless other lifestyle choices, contribute to higher health care costs, yet job candidates in these categories, the authors note, are not singled out for discrimination.
Conclusions
Support for healthful behaviors is a better way to get employees to stop smoking, say the authors. In hiring decisions, employers should focus on whether candidates meet the job requirements; then they should provide genuine support to employees who wish to quit smoking, whether through evidence-based cessation programs, nicotine-replacement therapy, or psychological support.
Note: The counterpoint to this argument was also presented in the March 27 issue of the New England Journal of Medicine.
