You don’t need me to tell you that smoking is bad for you; that it lowers your life expectancy and increases your risk for cancer, lung disease, heart disease and too many other illnesses to name. Some 19 percent of Americans 18 and over smoke and tobacco is responsible for one out of five deaths — 440,000 a year. People still smoke despite all this, so shouldn’t some more drastic steps be taken — like banning them from jobs?
Or is such a ban a completely wrong-headed approach? Isn’t smoking a choice? If people decide to do it (and I know plenty who do, including quite a few of my 20-something college students), they are doing so in full knowledge of the dangers and consequences.Two groups of academics at the University of Pennsylvania debated these issues in separate articles in the leading medical journal The New England Journal of Medicine.
Not Hiring Smokers Is Job Discrimination
A no-smoker hiring policy is “discriminatory and unethical,” says the first article, which is by Harald Schmidt of the University of Pennsylvania’s institute of health economics, Kristin Voigt of McGill University and Ezekiel Emanuel, an administrator and professor of medical ethics and health policy at Penn.
29 states have indeed passed laws “prohibiting employers from refusing to hire job candidates because they smoke.” But we need to keep in mind the tobacco industry’s role in funding efforts to influence state legislatures. Not surprisingly, more contributions from the tobacco industry mean that a state has a lower “tobacco policy score,” Schmidt, Voigt and Emanuel write in their article, The Ethics of Not Hiring Smokers.
They also point out that it is hardly the case that people can just quit as smoking is addictive. Plus, rates of tobacco use vary among socioeconomic groups, with these being higher among those who are poorer and have less education. Rather than penalizing people for circumstances they are not entirely in control of, we need to increase “support for healthy behaviors.”
Not Hiring Smokers Can Motivate Them to Quit
The CEO of the University of Pennsylvania Health System, Ralph Muller, is one of the authors of the second article, Conflicts and Compromises in Not Hiring Smokers. The health system’s announcement that it will no longer hire smokers after July 1 indeed prompted the two articles. This article’s other authors are David Asch and Kevin Volpp, who are both professors at both Penn’s Perelman Medical School and at the Wharton School of Business.
Right from the start, the second article singles out tobacco use as “the single greatest cause of preventable deaths across the country,” as Hoag Levins writes in LDI Health Economist. In recognition of the limited and minimal effect of “gentler” methods to get people to quit smoking (such as pointing out the numerous ways tobacco can injure one’s health or higher insurance premiums for smokers), the researchers argue that “controversial” measures are in order.
Asch, Volpp and Muller cite the 2007 conceptual “Intervention Ladder” (pdf) proposed by the United Kingdom’s Nuffield Council on Bioethics. This “ladder” contains eight levels that rate health interventions on eight levels, from “Do nothing or simply monitor the current situation” to “Eliminate choice: make tobacco use illegal.” As Levins points out, “in all the years that U.S. health authorities have battled tobacco and tallied up the hundreds of thousands of annual dead, we’ve only partially ascended that ladder.”
Asch, Volpp and Muller indeed take into account that a no hiring of smokers measure would disproportionately affect those from “disadvantaged populations,” but point out that these very individuals are “at the greatest risk of smoking-related harms and ensuing disparities in health.” They also acknowledge that a no smokers ban is potentially coercive and an infringement on civil rights. Their argument is that “behaviors that were once seen as exclusively private often have profound societal effects;” that the benefits for one’s health and financial status are “in the long run… for their own good.”
Yes, it is better not to smoke. Does getting people to quit smoking merit such a paternalistic approach in which people are given no choice — except the choice to have a job or not?
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