Skip to main content

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?

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
December 20, 2014 -- Updated 0242 GMT (1042 HKT)
Conservatives know easing the trade embargo with Cuba is good for America. They should just admit it, says Fareed Zakaria.
December 20, 2014 -- Updated 0112 GMT (0912 HKT)
We're a world away from Pakistan in geography, but not in sentiment, writes Donna Brazile.
December 19, 2014 -- Updated 1709 GMT (0109 HKT)
How about a world where we have murderers but no murders? The police still chase down criminals who commit murder, we have trials and justice is handed out...but no one dies.
December 18, 2014 -- Updated 2345 GMT (0745 HKT)
The U.S. must respond to North Korea's alleged hacking of Sony, says Christian Whiton. Failing to do so will only embolden it.
December 19, 2014 -- Updated 2134 GMT (0534 HKT)
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
December 18, 2014 -- Updated 1951 GMT (0351 HKT)
Jeff Yang says the film industry's surrender will have lasting implications.
December 18, 2014 -- Updated 2113 GMT (0513 HKT)
Newt Gingrich: No one should underestimate the historic importance of the collapse of American defenses in the Sony Pictures attack.
December 10, 2014 -- Updated 1255 GMT (2055 HKT)
Dean Obeidallah asks how the genuine Stephen Colbert will do, compared to "Stephen Colbert"
December 18, 2014 -- Updated 1734 GMT (0134 HKT)
Some GOP politicians want drug tests for welfare recipients; Eric Liu says bailed-out execs should get equal treatment
December 18, 2014 -- Updated 1342 GMT (2142 HKT)
Louis Perez: Obama introduced a long-absent element of lucidity into U.S. policy on Cuba.
December 16, 2014 -- Updated 1740 GMT (0140 HKT)
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
December 17, 2014 -- Updated 1600 GMT (0000 HKT)
The Internet is an online extension of our own neighborhoods. It's time for us to take their protection just as seriously, says Arun Vishwanath.
December 16, 2014 -- Updated 2154 GMT (0554 HKT)
Gayle Lemmon says we must speak out for the right of children to education -- and peace
December 17, 2014 -- Updated 1023 GMT (1823 HKT)
Russia's economic woes just seem to be getting worse. How will President Vladimir Putin respond? Frida Ghitis gives her take.
December 17, 2014 -- Updated 0639 GMT (1439 HKT)
Australia has generally seen itself as detached from the threat of terrorism. The hostage incident this week may change that, writes Max Barry.
December 12, 2014 -- Updated 2020 GMT (0420 HKT)
Thomas Maier says the trove of letters the Kennedy family has tried to guard from public view gives insight into the Kennedy legacy and the history of era.
December 15, 2014 -- Updated 1456 GMT (2256 HKT)
Will Congress reform the CIA? It's probably best not to expect much from Washington. This is not the 1970s, and the chances for substantive reform are not good.
December 15, 2014 -- Updated 2101 GMT (0501 HKT)
From superstorms to droughts, not a week goes by without a major disruption somewhere in the U.S. But with the right planning, natural disasters don't have to be devastating.
December 15, 2014 -- Updated 1453 GMT (2253 HKT)
Would you rather be sexy or smart? Carol Costello says she hates this dumb question.
December 14, 2014 -- Updated 2253 GMT (0653 HKT)
A story about Pope Francis allegedly saying animals can go to heaven went viral late last week. The problem is that it wasn't true. Heidi Schlumpf looks at the discussion.
December 14, 2014 -- Updated 1550 GMT (2350 HKT)
Democratic leaders should wake up to the reality that the party's path to electoral power runs through the streets, where part of the party's base has been marching for months, says Errol Louis
December 13, 2014 -- Updated 2123 GMT (0523 HKT)
David Gergen: John Brennan deserves a national salute for his efforts to put the report about the CIA in perspective
December 12, 2014 -- Updated 1426 GMT (2226 HKT)
Anwar Sanders says that in some ways, cops and protesters are on the same side
December 11, 2014 -- Updated 1439 GMT (2239 HKT)
A view by Samir Naji, a Yemeni who was accused of serving in Osama bin Laden's security detail and imprisoned for nearly 13 years without charge in Guantanamo Bay
December 14, 2014 -- Updated 1738 GMT (0138 HKT)
S.E. Cupp asks: How much reality do you really want in your escapist TV fare?
ADVERTISEMENT