Smokers Need Not Apply

February 27, 2013

By Alan Regenberg

The University of Pennsylvania Health System has announced that, effective July 1, 2013, they will cease hiring tobacco users “in our efforts to improve the overall health of our work force while reducing health care benefit costs.” Current employees (and hired non-tobacco users who begin to use tobacco) will pay a higher premium for their health care coverage.


Screening will be completed by self-report; new applicants will be asked to “attest” that they are non-tobacco users on their employment application.  Falsification could be grounds for termination.


Penn’s clinical practices on the NJ side of the Delaware River will be exempted from this policy, as NJ state law “restrict(s) employers from having policies that limit employment opportunities based upon tobacco use.”


While the explicit, immediate goal is to improve the health of Penn’s workforce while reducing health care costs, they also note a broader commitment to a “tobacco free future.”


One obvious problem: arbitrariness. Is it fair to single out tobacco users and punish them for their health-related behaviors while there are all sorts of easily identifiable groups that could be treated similarly (but are not) based on the same rationale?  For example, why not set a limit on  body mass index or even people who participate in sports associated with high rates of injuries?


In at least some cases – and this one in particular –the practical merits and potential benefits can outweigh most potential harms related to arbitrariness/fairness concerns.


Smoking poses dire health risks. If we assume that this policy offers an effective tool for discouraging smoking, then I’m not sure that the policy-makers have any obligation to delay implementation until such time as there are similar policies available for every single other behavior associated with bad health outcomes.


Of course, this hinges on the policy offering reasonable prospects of achieving its goals.  To their credit, Penn addresses this directly, writing that “there is no longitudinal study that provides demonstrable evidence that employers who cease hiring tobacco users reduce overall health care costs”. They attribute this to a general dearth of data and experience. So, we can’t prove that this will work, but we can’t prove that it won’t, either.


This response suggests that Penn is interested in, and in fact I think there is an obligation to, carefully assess effectiveness. If this evaluation demonstrates that the policy is not achieving its goals, then this undermines the rationale for its implementation and would require changes.


Setting these issues aside, I think that the screening methods present the biggest challenge for this policy.  Asking applicants to attest to their own abstinence seems unlikely to yield particularly reliable results. There are pretty substantial incentives for applicants to lie. This seems to play out in similar ways to other venues where we assume that individuals have a right against self-incrimination. This also seems like a really bad starting point for an employer-employee relationship.


Alan Regen
berg, MBe, is the Bioethics Research Manager at the Johns Hopkins Berman Institute of Bioethics. He is currently developing and implementing strategies to use social media as a tool for broad public engagement around issues in bioethics. You can follow him  @bermaninstitute or, using his inside voice, @aregenberg.

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Alan Regenberg

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