Are hospital hiring policies banning smokers extreme or economical?

Healthier workplace may mean fewer job opportunities and freedoms for some


The sight is as disjointed as it is common: Hospital workers standing on the sidewalk, in their scrubs, smoking a cigarette.


But it appears that more medical facilities are adopting strict policies aimed at fostering, not just a smoke-free environment, but a smoker-free workplace.


According to a Feb. 10 New York Times article, these measures include turning away job applicants who smoke, submitting workers to a urine test for nicotine, or in one case retold in the story, firing an employee who secretly stepped out for a cigarette.


The article also pointed out that, of the 29 states that prohibit employers from adopting hiring policies, some of them make an exception for health care organizations.


One can imagine several basic arguments in support of not hiring smokers: Hospitals and medical offices may want to take a symbolic stance that conveys disapproval of an obviously unhealthy behavior. Another justification is that smokers—due to their increased health risks—unfairly raise medical-plan rates for their non-smoker co-workers.


A third reason that a medical facility may want to enforce strict anti-smoker policies is to discourage people who may be interested in applying for a job from picking up the habit in the first place—a rationale that both smacks of paternalism, and lacks evidence to support it.


At the same time, these policies may ultimately not be about improving health. Rather, they could be an attempt by employers to both assert more control over their workers and reduce the cost of subsidizing health care.


The symbolic importance does not justify singling out smokers who seek work in the health care sector, according to Adnan Hyder, an associate professor at the Johns Hopkins Bloomberg School of Public Health. Hospitals and other medical facilities should not be able to exert more moral authority than other employers simply because of their public-health mission.


“There’s no difference between the health-care industry and other industries,” Hyder said. “But the economic argument does hold up across employment sectors.”


Research scholar Dan O’Connor views these policies as consistent with what seems to be a growing trend in this country of stripping away the rights of workers. “It’s mortally depressing,” he said.


The article, “Hospitals Shift Smoking Bans to Smoker Ban,” says the policies reflect the failure of gentler efforts to discourage smoking among employees—such as offering monetary incentives to participate in cessation programs, or imposing a smoke-free buffer around a facility.


The story explained how large companies such as Alaska Airlines, Union Pacific and Turner Broadcasting adopted policies against hiring smokers about 20 years ago. In response, 29 states and the District of Columbia passed laws—with strong backing by cigarette makers and the American Civil Liberties Union—that prohibit discrimination against smokers who use “lawful products,” according to the article.


Is it discrimination?

Hilary Bok, the Henry R. Luce Professor of Bioethics and Moral and Political Theory at Johns Hopkins University, questions whether a hiring policy that excludes individuals based on habit—a “mutable” characteristic—can indeed be called “discrimination.” Discrimination has conventionally targeted “immutable” characteristics such as age, race or gender.


“An employer says, ‘I don’t think people have a right to smoke and get a job,’” Bok began by saying. “Does calling this discrimination change the meaning of discrimination?”


Is it good policy?

Measuring the public health impact of policies can be complex and difficult to do immediately. Psychiatry Prof. Peter Rabins used the example of the Prohibition, the complete outlawing of alcohol throughout the country in the 1920s and 1930s in the name of public health. Although the ban was successful in dramatically reducing cirrhosis rates, Rabins said the era also gave rise to organized crime and violent deaths.


In addition to not being able to predict the long-term consequences of public health efforts, our evolving understanding of addiction also undermines the case against hiring smokers. Certain demographic and socioeconomic factors have been shown to indicate who is likely to be a smoker. But there seems to be less insight into the individual choices people actually make—and further, the sorts of policies that will help individuals resist addictions and result in the desired outcomes.


“These policies tend to suggest that there is ‘choice’ involved,” said Nancy Kass, the Berman Institute’s deputy director for public health.


In the meantime, these policies have the potential to create an even tougher job market for lower-skilled workers who smoke without actually helping them to quit. “Smoking could be that ‘just one more thing’ that gets taken away from someone who already has little left to lose,” O’Connor said.

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Adnan Hyder
Daniel O'Connor
Hilary Bok
Michael Pena
Nancy Kass
Peter Rabins

One Response to “Focus On: No Smokers at Work”

  1. Mario says:

    Prof. Bok is clouding the issue. Religion is a mutable characteristic and often an object of unjust discrimination. Discrimination against homosexuals pertains as much to how they live and what they do, which are mutable, as it does to what they are. Size-ism, or discrimination against the obese, also targets a mutable characteristic. The so-called conventional concept of discrimination is not that at all. Her reasoning invents an arbitrary and new concept of discrimination, one fashioned to be able to exclude smoker discrimination and any other mutable characteristic such as religion. But definitions do not create reality. Unjust discrimination is what it is, regardless of how people manipulate the definition to justify what they want to do. To answer Bok’s question, not calling it discrimination changes the meaning of discrimination.

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