Dueling perspective articles in this month’s New England Journal debate whether it is ethical for employers to refuse to hire smokers. Health care employers (including the University of Pennsylvania Health System, which is owned by my employer and the employer of most of the authors) have led the way with these hiring bans.
Harald Schmidt, Kristin Voigt, and Ezekiel Emanuel argue that the burden that such policies place on smokers have the practical effect of increasing the disadvantage of an already vulnerable group, and moreover that other policies could achieve the same outcome with less burden:
” It is callous — and contradictory — for health care institutions devoted to caring for patients regardless of the causes of their illness to refuse to employ smokers. Just as they should treat people regardless of their degree of responsibility for their own ill health, they should not discriminate against qualified job candidates on the basis of health-related behavior.”
David Asch, Ralph Muller, and Kevin Volpp counter that it is not only permissible, but ultimately beneficial to smokers and non-smokers to have the policy in place. They remind us that the policies help to accelerate a decision many smokers would like to make:
“In many surveys, about 70% of smokers say they want to quit, but only 2 to 3% succeed each year. One reason for this huge gap is that smoking cessation has immediate costs in the form of nicotine withdrawal (i.e., the symptoms of withdrawal and the costs of antismoking treatments), but its benefits in terms of improved health are considerably delayed. Thus, although some people may see anti-tobacco hiring policies as adding economic injury to physical injury, we would argue that such policies also make the benefits of smoking cessation more immediate and so help to counterbalance the immediate costs of quitting.”
The pieces are ungated, so go read them yourselves! My immediate reaction is that (1) against Schmidt et al. I disagree that we need to believe that smokers are personally responsible for their behavior to impose the ban, we just need to believe that the ban is likely to get them to change, (2) I am not categorically against tough love paternalism for behaviors that are very harmful, (3) but such policies require a huge hurdle to jump over — we have to show that there is no credible alternative that would achieve the same outcome. I’m not sure we have jumped that hurdle here, and so I am leery of these bans.
More good coverage from the LDI economist.
(Full disclosure, David Asch is one of my mentors, and Harald Schmidt and Kristin Voigt are friends)