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: Continue reading