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Barring smokers from hospital jobs unfair

By Arthur Caplan, Special to CNN
March 1, 2013 -- Updated 1225 GMT (2025 HKT)
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?

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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.

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

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