From the medical side, arguing for smokers' rights
"Even as a non-smoking future physician imploring my patients to quit, I will fight in the defense of equality for smoking citizens."
From the medical side, arguing for smokers' rights
Jon Kole is in his fourth and final year of a combined MD and Masters of Medical Ethics program at the University of Pennsylvania.
By Jon Kole
What do Cleveland Clinic, the World Health Organization, and Geisinger Health System in central Pennsylvania have in common? They all reject new job applicants who use cigars, cigarettes or other tobacco products. And here in Philadelphia the University of Pennsylvania Health System recently announced that it too, effective July 1, “will cease hiring tobacco users in our efforts to improve the overall health of our workforce while reducing health care benefit costs.”
But should smokers be prohibited from employment? Is this a just policy?
There's no doubt that smoking is enormously harmful to health. The Centers for Disease Control and Prevention reports that smoking contributes to about one in five deaths (more than 400,000) a year in the United States. Smoking not only causes cancer, heart disease, stroke, and lung diseases, but it generally worsens physical condition. Because of this, policies that preclude hiring smokers have been upheld by the courts for certain jobs, such as firefighting, in which smoking can be immediately detrimental to performance .
Second-hand smoke is also a significant health problem, killing an estimated 49,000 Americans a year and worsening the health of many more. The individual act of smoking can harm others in the nearby vicinity. Justifiably, the number of public spaces that tolerate smoking has dramatically declined. Employers, interested in the safety of all of their workers, are within their legal and ethical rights to prevent smoking on company property.
But what about the individuals smoking at home, alone, on their own time – and hoping to get a job during the day?
The implications for hiring only non-smokers might, at first glance, seem beneficial. Smoking employees are estimated to cost employers nearly $3,400 a year, a large sum that any company would like to avoid. Many health systems want to model good health practices; they believe that smoke-free hiring sends a positive signal to the community. With the well-intentioned goal of encouraging Americans to stop smoking, some public health advocates and medical organizations (like the American Lung Association) support these hiring bans.
The problem is that these policies are inherently discriminatory (and, as a result, have been prohibited by 29 states, including New Jersey, and the District of Columbia). What is it about someone smoking at home that makes him or her less worthy of employment?
There are 43.8 million smokers in the U.S., many of whom, I imagine, would be ideal employees. If the federal Government had embraced a no-smokers policy in 2008, we would have a different person sitting in the Oval Office. We have numerous laws to protect those with disabilities and illnesses from stigma-based hiring practices. People who smoke deserve nothing less.
Opponents point out that smokers are different than the other protected classes because they have a choice. People don’t choose to be disabled, the argument goes, but they choose to smoke. This is simply not true. Sixty nine percent of current adult smokers say they wish to quit immediately and completely, yet most continue. The average number of quit attempts prior to successful smoking cessation is more than five. Nicotine is remarkably addictive – chemically speaking, even more so than most illicit drugs.
Even the first puff is not a free choice. If it was, differences in smoking rates would be random. Yet smoking rates are significantly higher among the long-term unemployed, homeless, mentally ill, prisoners, single parents, and certain ethnic minorities. If you are poor, you have a greater likelihood of being exposed to and starting smoking. Thus, a non-smoking-only hiring policy means that some of the people that most need jobs may be denied the right to obtain them.
Even if we could imagine smoking as purely a willful choice, the argument for non-hiring still falls short. If smoking employees cost employers a discreet amount more than non-smokers, the employees could be allowed to pay the difference. A number of employers (including Penn) create a set health insurance surcharge to allow smokers to choose to pay the toll of their behavioral choice. A hiring ban denies this opportunity. Policies should aim towards justice, whether or not it involves a Marlboro.
Beyond discrimination, singling out smokers in hiring is arbitrary. While smoking certainly is a significantly harmful health behavior, it is not the only one. A 2012 study in the Archives of Internal Medicine found that each daily increase of three ounces of processed red meat (like bacon) is associated with greater than 20 percent greater risk of cancer, heart disease, and death. People ride motorcycles without helmets, which the CDC estimates increases health costs up to $1,600 a year, without fear of unemployment. The fact that more people smoke than wrestle alligators does not change either activity’s inherent risk or unhealthiness. If we allow this ban to be justified by saving company health-care costs and improving employee health, where do we stop? Are we ready to let companies preferentially hire vegetarians after checking our stool for animal protein?
Ethics aside, the practical implications of screening for nicotine are off-putting. These nicotine tests are known to be quite sensitive. Small but detected concentrations of nicotine metabolites (up to amounts present after having smoked three cigarettes) may be found in the saliva or urine of non-smokers who have been exposed to tobacco smoke for several hours. Are we comfortable with not hiring the non-smoking roommate of a smoker? Would we hire smokers who abstain for their week of testing and then return to their habit? (The University of Pennsylvania Health System says it will ask job applicants whether they smoke but will not screen them.)
From California to Maine, Minnesota to Louisiana, a cigarette does not prevent a paycheck. We must call on our legislators in Harrisburg to join the wiser majority of the nation and prevent unjust hiring practices. Even as a non-smoking future physician imploring my patients to quit, I will fight in the defense of equality for smoking citizens. Smokers deserve fair protection under the law. And besides, I want my bacon cheeseburger.
Read more about The Public's Health.
While I appreciate Jon's sympathy for smoker's rights, I believe the public being served by these medical institutions deserves protection from the toxic presence of tobacco use by employees. I feel the same protection should be expanded to all food handling institutions as well, including grocery stores and restaurants. Public health and safety should trump an individual's "right" to smoke. I want my bacon cheeseburger, too, but not served by someone whose hands, breath and clothing are fouled by smoke. The larger issue should not be the institutions saving money by not hiring smokers, but it should be about public health and safety.— mspillane- sorry, spillane - your bacon cheeseburger is NEXT! Can't have it.— Mirror
- I believe that to signal out a smoker and then deny unemployment is discrimination. I have no problem with banning smoking in the workplace, bars, etc., however, if we deny smokers the right to work - what is next - do not hire the obese, the diabetic, the person who drinks too much - these all have equally high health care costs. I am a smoker and have smoked for 30 years and have never had to call out sick, etc. for a smoking related illness, my chest XRAYS are clear - good genetics, maybe, but should I be discriminated against - no! I have co-workers who are overweight and go to the doctors alot due to weight issues - knee replacements, diabetes, hernias - they are certainly costing my employer alot more than I am. And I do not smell like an ashtray - washing your hands, doing the laundry, etc. takes care of these issues. Smoking like it or not is legal in this country. The issue is about rights. A very good article— dannerd
- The obvious solution here is to change the system so that employers' costs don't go up due to employees' unhealthy lifestyles. That might be done by passing the cost on to the employees, or by not offering health insurance through the employer (give the employees the money that would have been spent on them and let them buy from any insurer they choose). We really need to move away from employer-sponsored health insurance where the only option that makes financial sense is to accept whatever plan your employer offers. I definitely would not have chosen the plan my employer chose for me.— Jasper38
- A very reasonable argument, and some good posts prior to mine.
As an ex smoker of 20 years, I can see both sides here, I think. It is a horrific habit and I believe that all smokers want to quit but like the article says, struggle. That said, I hate being near smoky entrances now. Or outside bars. Truly disgusting. I now know what non smokers used to think of us while we puffed away outside. And the stink on clothes - yuk. However all that said, it is a slippery slope to start banning smokers as employees. Encourage them to quit - make it hard to smoke while on duty, but don't ban them.— Poppys - I'm a smoker also. I pay that extra "fee" for my medical insurance. I pay taxes on the cigarettes that do not necessarily to go helping to quit smoking or for making cigarettes less addictive. If smokers are prohibited from work, they will be on unemployment lines. But the kicker is that tobacco will never be banned outright because it is a good source of revenue. Note that the more people quit the higher the cigarette/tobacco tax. Let me say that there is a social snobbery here, as if smokers are monsters or lepers, less than human, to be looked down upon, shunned, and exiled. It has become politically and socially incorrect to smoke.
— pocketnunu - 1) My great uncle and uncle both smoked all their lives. My great uncle died around age 84 and my uncle is still alive in his 80s.
2) Conversely, I have seen nonsmokers die in their 60s from heart attacks -- probably because they ate too much and were obese. Or were to lazy to turn off the TV and get some exercise. Does anyone want to guess the health costs of legalizing marijuana?
3) People ban smoking outdoors under a fallacious claim of second hand smoke and their "rights" being infringed. But the rest of us have to endure major environmental degradation because those same liberals want to bring a million new immigrants in every year. We all infringe on each other just by living.
4) It was reasonable for non-smokers to object to smoking indoors -- but we have long since passed the point of reasonableness. We are seeing characteristic liberal intolerance, liberal yearning for totalitarianism and liberal whoring for the insurance companies' profits.
5) Plus liberal whoring for Wall Street firms has resulted in 25 million unemployed for 4 years -- so why should they care about a couple million more people being thrown out on the unemployment line?— DonxWilliams - Do you seriously believe that secondhand smoke is a "fallacious" claim? Have you ever seen someone with asthma walk through a cloud of secondhand smoke? They start hacking up a lung. This happens to my gf MANY times whenever we leave a public building and she has to walk through the clouds of secondhand smoke. — uncle meat
- I'm one of those people. I have a difficult time breathing and my chest tightens up. I have the same reaction to someone who's where too much perfume.
@DonxWilliams - as soon as what you're doing has no effect on my health, you can do it wherever. But, until then, you'll just have to deal with your limited places to smoke.— PotteryPete - THE ABUSE THE HUMAN BODY CAN TAKE IS AMAZING
— TimmyDay - The equal rights of a smoker have been totally stripped in “hotels”, “bars”, “casinos”, on the “beach”, especially “outdoors”. We stayed at one of the Disney resorts that had a wooded theme with a very quiet setting. I had to walk 2 blocks to a smoking area. If I’m spending $300 a night for my stay, I expect to be able to sit out front of the room to smoke. Yet the people 4 doors down are sitting outside their room DRINKING, SMOKING POT, and God know what else….. I have to walk TWO BLOCKS TO SMOKE; but it is O.K. that MY GRANDCHELDREN HAVE TO SMELL “POT”!!!! It is getting out of hand.
The government should spend more time worrying about the world drug and alcohol. “Drugs and Alcohol” as well as smoking cause health problems; additionally, it causes people to have mental issues. It is a well known fact that people that are into drugs and alcohol live a life of destruction to themselves, their families, friends, neighbors, etc. Additionally, the world of DRUGS IS ALSO A WORLD OF CRIME!
— ttamb - I'm against the idea of employers not hiring smokers, but "equal rights" of smokers? Really?
You absolutely have every right to smoke. It's your body, your life. But, the minute you light that smoke up around me, you've removed my rights to NOT smoke. I no longer have a choice. Out of 300 million people, 43 million of you smoke, majority should rule and you should only be able to smoke where it's not going to harm the rest of us who have chosen not to smoke.— PotteryPete - And not hiring smokers is definitely the first step towards encouraging more alcohol and drug abuse... — drdave
- >>>>>>>>>>>Second-hand smoke is also a significant health problem, killing an estimated 49,000 Americans a year and worsening the health of many moreThis is as far as I read....... There is zero scientific evidence for this kind of Holocaust-like death toll. (HTML deleted)— cementhead
- All I know is that smokers smell like burning garbage, so I avoid them like the plague. And I think any employer would be sensible to reject applicants that have a horrible stench on them. One time I went to a job interview after I had been sprayed by a skunk, and I didn't get the job, so I'm thinking it must have been that skunk smell. It's the same thing if you have that disgusting smoke stink on you.— pic man
