Skip to main content

Barring smokers from hospital jobs unfair

By Arthur Caplan, Special to CNN
updated 7:25 AM EST, Fri March 1, 2013
Arthur Caplan says some hospitals are declining to hire smokers. But the move doesn't pass the ethical smell test.
Arthur Caplan says some hospitals are declining to hire smokers. But the move doesn't pass the ethical smell test.
STORY HIGHLIGHTS
  • The University of Pennsylvania Health System said it will no longer hire smokers
  • Arthur Caplan: Keeping smokers out of the hospital work force is ethically hard to digest
  • He says it's there are many unhealthy habits out there. It's unfair to make them job killers
  • Caplan: Shouldn't doctors and nurses learn to work with those who stray from good health?

Editor's note: Arthur Caplan is the Drs. William F and Virginia Connolly Mitty professor and director of the Division of Bioethics at New York University Langone Medical Center.

(CNN) -- The University of Pennsylvania Health System in Philadelphia recently announced that it will no longer hire smokers. A job applicant must be tobacco-free for six months to qualify for a position there.

This decision will surely prove popular. Defending the dirty habit of smoking is now left to fat cat lobbyists, highly paid lawyers with no conscience and far-right-wing crackpots. I am not in those ranks. (Full disclosure: I was a former employee of the university.)

But, keeping smokers out of the hospital work force unless it protects patients makes me very nervous. Ethically, it is hard to digest.

Arthur Caplan
Arthur Caplan

Penn is not the first health care institution to go tobacco-free in hiring. The Cleveland Clinic did so back in 2007. The Geisinger Health System in northern Pennsylvania has had such a policy complete with required nicotine testing for more than a year. Hospitals and health systems in Florida, Georgia, Massachusetts, Missouri, Idaho, Virginia, Ohio, Tennessee and Texas have all stopped hiring smokers.

Lots of companies outside health care are not hiring smokers either, but the big push is in hospitals and health systems. So what is wrong with not hiring those who engage in (or have engaged in) a gross, sickening, bad habit?

Become a fan of CNNOpinion
Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.



In justifying its decision, Penn says smoking and secondhand smoke contribute to 443,000 premature deaths a year and cost $193 billion in health care and lost productivity. So, clearly they want to try and make a dent in that bill by barring tobacco users.

In addition, Penn notes on its website that, "Employees who smoke cost, on average, $3,391 more a year for health care. In addition, smoke breaks during work may be disruptive and subject patients/colleagues to the unpleasant smell of smoke on employees' scrubs and clothing."

So the two big reasons are making a dent in a costly bad lifestyle choice and saving money for the health care system by hiring tobacco-free employees. I am not sure if I buy the smoke break disruption or the smelly clothes arguments. If they are problems, then send the smokers outside to a spot far away from where the patients come in and out, or have them wash their hands and faces, which everyone ought be doing anyway, and only give them the same breaks from work that everyone else gets.

It comes down to a matter of fairness. Why can't the hospital work with people who may want to change their behavior but are having a hard time doing so? There's a little hypocrisy when as a place where you bring people back from sickness to health, your policy seems to reflect little concern for getting health care workers to become healthier.

I don't doubt smokers cost us all a lot of money. It is also cheaper not to have to hire them and give them insurance or see them miss work. But the obese, the gamblers, rugby players, skiers, the sedentary, the promiscuous who don't practice safe sex, those who won't wear helmets on motorcycles and bikes, horseback riders, pool owners, all-terrain-vehicle operators, small-plane pilots, sunbathers, scuba divers, and surfers -- all of whom cost us money and incur higher than average health care costs -- are still on the job.

Picking on the smokers alone is simply not fair. And what message does a no-smokers-are-welcome policy send? We don't want you in our health care system?

Shouldn't doctors and nurses learn to work with those who sin and stray from the dictates of good health? As long as those who have bad habits are not compromising the quality of health care being provided on hospital ground, then let's not exclude smoking nurses, fat physical therapists, and scuba diving pharmacists from work.

What is the best way to get a doctor or nurse who smokes to stop? Make sure they cannot get a job? Oh yeah -- that will surely make them kick the habit! Why not hire them, tell them they have to get into anti-smoking programs and pay them a bonus when they stay smoke-free?

Not hiring smokers at hospitals does send a message -- but it isn't one that hospitals and health systems ought to be sending.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Arthur Caplan.

ADVERTISEMENT
Part of complete coverage on
updated 9:05 AM EDT, Tue September 16, 2014
LZ Granderson says Congress has rebuked the NFL on domestic violence issue, but why not a federal judge?
updated 7:49 AM EDT, Tue September 16, 2014
Mel Robbins says the only person you can legally hit in the United States is a child. That's wrong.
updated 1:23 PM EDT, Mon September 15, 2014
Eric Liu says seeing many friends fight so hard for same-sex marriage rights made him appreciate marriage.
updated 3:38 PM EDT, Mon September 15, 2014
SEATTLE, WA - SEPTEMBER 04: NFL commissioner Roger Goodell walks the sidelines prior to the game between the Seattle Seahawks and the Green Bay Packers at CenturyLink Field on September 4, 2014 in Seattle, Washington. (Photo by Otto Greule Jr/Getty Images)
Martha Pease says the NFL commissioner shouldn't be judge and jury on player wrongdoing.
updated 9:15 AM EDT, Tue September 16, 2014
It's time for a much needed public reckoning over U.S. use of torture, argues Donald P. Gregg.
updated 8:25 AM EDT, Tue September 16, 2014
Peter Bergen says UK officials know the identity of the man who killed U.S. journalists and a British aid worker.
updated 7:28 AM EDT, Tue September 16, 2014
Joe Torre and Esta Soler say much has been achieved since a landmark anti-violence law was passed.
updated 4:55 PM EDT, Fri September 12, 2014
David Wheeler wonders: If Scotland votes to secede, can America take its place and rejoin England?
updated 8:41 AM EDT, Tue September 16, 2014
Jane Stoever: Society must grapple with a culture in which 1 in 3 teen girls and women suffer partner violence.
updated 4:36 PM EDT, Fri September 12, 2014
World-famous physicist Stephen Hawking recently said the world as we know it could be obliterated instantaneously. Meg Urry says fear not.
updated 6:11 PM EDT, Fri September 12, 2014
Bill Clinton's speech accepting the Democratic nomination for president in 1992 went through 22 drafts. But he always insisted on including a call to service.
updated 6:18 PM EDT, Fri September 12, 2014
Joe Amon asks: What turns a few cases of disease into thousands?
updated 1:21 PM EDT, Thu September 11, 2014
Sally Kohn says bombing ISIS will worsen instability in Iraq and strengthen radical ideology in terrorist groups.
updated 1:30 PM EDT, Thu September 11, 2014
Analysts weigh in on the president's plans for addressing the threat posed by the Islamic State of Iraq and Syria.
updated 9:27 AM EDT, Thu September 11, 2014
Artist Prune Nourry's project reinterprets the terracotta warriors in an exhibition about gender preference in China.
updated 9:36 AM EDT, Wed September 10, 2014
The Apple Watch is on its way. Jeff Yang asks: Are we ready to embrace wearables technology at last?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT