When Businesses Refuse To Hire Smokers

A number of employers, both health-related and not, have established policies of not hiring smokers, The New England Journal of Medicine reports today as part of a larger look at the ethics of such controversial measures. These businesses, including the Cleveland Clinic, Geisinger, Baylor and the University of Pennsylvania Health System and the Union Pacific Railroad and Alaska Airlines, have various rationales for their decision to exclude tobacco users. And in an NEJM perspective piece, authors David A. Asch, M.D., M.B.A., Ralph W. Muller, M.A., and Kevin G. Volpp, M.D., Ph.D., all of Philadelphia, lay out several reasons why these policies are taking hold:

Tobacco use is responsible for approximately 440,000 deaths in the United States each year — about one death out of every five. This number is more than the annual number of deaths caused by HIV infection, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined1 and more than the number of American servicemen who died during World War II.

smokerA small but increasing number of employers…have established policies of no longer hiring tobacco users. These employers might justify such hiring policies in many ways — arguing, for instance, that they’re taking a stand against a habit that causes death and disability, that they’re sending an important message to young people and others within their communities about the harms of smoking, or that they’re reducing their future costs, given that smokers, on average, cost employers several thousand dollars more each year than nonsmokers in health care expenses and lost productivity.

But in a companion piece, doctor and health policy expert Ezekiel Emanuel and others write that it’s “paradoxical,” and even wrong to single out smokers by refusing them employment:

Yet it seems paradoxical for health care organizations that exist to care for the sick to refuse to employ smokers. Many patients are treated for illnesses to which their behavior has contributed, including chronic obstructive pulmonary disease, heart failure, diabetes, and infections spread through unprotected sex or other voluntary activities. It is callous — and contradictory — for health care institutions devoted to caring for patients regardless of the causes of their illness to refuse to employ smokers. Just as they should treat people regardless of their degree of responsibility for their own ill health, they should not discriminate against qualified job candidates on the basis of health-related behavior.

The broader claim that it is fair to exclude smokers because they are responsible for raising health care costs is too simplistic. It ignores the fact that smoking is addictive and therefore not completely voluntary. Among adult daily smokers, 88% began smoking by the time they were 18, before society would consider them fully responsible for their actions. Much of this early smoking is subtly and not so subtly encouraged by cigarette companies. As many as 69% of smokers want to quit, but the addictive properties of tobacco make that exceedingly difficult: only 3 to 5% of unaided cessation attempts succeed. It is therefore wrong to treat smoking as something fully under an individual’s control.

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.

So, what should employers do? Emanuel, et al write:

We believe that offering support for healthful behaviors is the best approach. Central in this regard is assisting employees by providing evidence-based smoking-cessation programs, removing cost barriers, facilitating access, and providing necessary psychological counseling and other support. For example, many employers, such as Walgreens, provide free nicotine-replacement therapy and smoking-cessation counseling to employees.

Readers, what do you think? Should smokers be punished for their sins, or might constructive engagement be the better path? Let us know.

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  • quit smoking after 30 years

    Smoking is a dirty pass time that effects everybody. I would not hire a smoker if there were equally qualified non smokers. They stink, take “breaks” and leave a mess. yuk

  • jmlorimer

    Even though I was a smoker 45 years ago, I would not want to work in close proximity to a smoker — even if a person doesn’t smoke in the same room, or even in the building, the smell clings to hair and clothing, and it STINKS! Ditto riding in a smoker’s car — it’s like sitting in a dirty ashtray. I think an employer should have the right to NOT hire people who smoke, especially if they are in close contact with other workers or the public. Maybe the policy would encourage job-seekers to quit smoking, and we’d ALL be better off.

  • http://www.facebook.com/vanessa.gunter.3 Vanessa Gunter

    Definitely a new form of discrimination – needs to be halted immediately.

  • pat

    Should be considered discrimination. What about people that drink? Have unprotected sex? Drive too fast?

  • Jan

    I’m actually thinking of turning down a contractor who is bidding on a construction project on my home because he smokes! I don’t want to smell his smokes for the three months he’ll be here.

    • pat

      I bet you would sit around a nice campfire though, right?

    • http://www.facebook.com/richard.hussong Richard Hussong

      Your objection is not to the contractor’s being a smoker, but to his smoking on your premises, right?. This is a different issue. If you otherwise want to hire him, you could write into the contract that he and his employees and subcontractors are not allowed to smoke on your property. If he won’t agree, there are other contractors.

      • canemetz

        I have done this routinely. No smoking on my property.

  • Andy

    I think this will be hard to defend in court. It also as you point out, seems disproportional unfair to poor applicants who on average smoke in higher percentages. I think it makes more sense to help with quitting rather than lock them out of the work force.