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 11:16 AM EDT, Thu August 28, 2014
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
updated 4:48 PM EDT, Thu August 28, 2014
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
updated 10:32 AM EDT, Thu August 28, 2014
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
updated 10:43 PM EDT, Thu August 28, 2014
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
updated 9:40 AM EDT, Thu August 28, 2014
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
updated 9:30 AM EDT, Fri August 29, 2014
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
updated 7:05 PM EDT, Thu August 28, 2014
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
updated 6:42 PM EDT, Tue August 26, 2014
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
updated 9:21 AM EDT, Wed August 27, 2014
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
updated 9:19 AM EDT, Wed August 27, 2014
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
updated 7:35 PM EDT, Tue August 26, 2014
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
updated 7:26 AM EDT, Wed August 27, 2014
Jeff Yang says the tech sector's diversity numbers are embarrassing and the big players need to do more.
updated 4:53 PM EDT, Tue August 26, 2014
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
updated 4:19 PM EDT, Tue August 26, 2014
Ed Bark says in this Emmy year, broadcasters CBS, ABC and PBS can all say they matched or exceeded HBO. These days that's no small feat
updated 3:19 PM EDT, Tue August 26, 2014
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
updated 11:58 AM EDT, Tue August 26, 2014
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
updated 3:50 PM EDT, Mon August 25, 2014
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
updated 4:52 PM EDT, Mon August 25, 2014
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
updated 12:29 PM EDT, Mon August 25, 2014
Peter Bergen and Emily Schneider say a YouTube video apparently posted by ISIS seems to show that the group has a surveillance drone, highlighting a new reality: Terrorist groups have technology once only used by states
updated 5:04 PM EDT, Mon August 25, 2014
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
updated 5:45 PM EDT, Fri August 22, 2014
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
updated 1:27 PM EDT, Tue August 26, 2014
John Bare says the Ice Bucket Challenge signals a new kind of activism and peer-to-peer fund-raising.
updated 8:31 AM EDT, Fri August 22, 2014
James Dawes says calling ISIS evil over and over again could very well make it harder to stop them.
updated 9:05 PM EDT, Sat August 23, 2014
As the inquiry into the shooting of Michael Brown continues, critics question the prosecutor's impartiality.
updated 6:47 PM EDT, Fri August 22, 2014
Newt Gingrich says it's troubling that a vicious group like ISIS can recruit so many young men from Britain.
updated 10:50 AM EDT, Thu August 21, 2014
David Weinberger says Twitter and other social networks have been vested with a responsibility, and a trust, they did not ask for.
updated 7:03 AM EDT, Fri August 22, 2014
John Inazu says the slogan "We are Ferguson" is meant to express empathy and solidarity. It's not true: Not all of us live in those circumstances. But we all made them.
updated 8:23 AM EDT, Fri August 22, 2014
Retired Lt. Gen. Mark Hertling says he learned that the territory ISIS wants to control is amazingly complex.
updated 3:51 PM EDT, Wed August 20, 2014
Cerue Garlo says Liberia is desperate for help amid a Ebola outbreak that has touched every aspect of life.
updated 1:42 PM EDT, Thu August 21, 2014
Eric Liu says Republicans who want to restrict voting may win now, but the party will suffer in the long term.
updated 11:38 AM EDT, Thu August 21, 2014
Jay Parini: Jesus, Pope and now researchers agree: Wealth decreases our ability to sympathize with the poor.
updated 8:00 AM EDT, Thu August 21, 2014
Judy Melinek offers a medical examiner's perspective on what happens when police kill people like Michael Brown.
updated 6:03 PM EDT, Tue August 19, 2014
It used to be billy clubs, fire hoses and snarling German shepherds. Now it's armored personnel carriers and flash-bang grenades, writes Kara Dansky.
updated 1:27 PM EDT, Wed August 20, 2014
Maria Haberfeld: People who are unfamiliar with police work can reasonably ask, why was an unarmed man shot so many times, and why was deadly force used at all?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT