Ethics: Not Hiring/Firing Those Who Smoke
There is a thread on this blog titled "Ethics of Smoking". It was started in April 2009 In that posting, a visitor wrote that her insurance company was " threatening their employees who will not quit smoking with a dock in pay of $25.00 per pay period, until they decide to quit. The employees must have quit for 12 weeks before they can be reimbursed the so-called surcharge."
The issue of companies non-hiring prospective employees or penalizing or firing employees who do not stop smoking continues on as an occupational, public health and ethical issue and dilemma. There are two opposing commentaries in the Perspective section of the April 11, 2013 issue of the New England Journal of Medicine with each looking at the two sides of the issue. The first commentary "Ethics of Not Hiring Smokers" presents the following conclusion: "By cherry-picking “low-risk” employees and denying employment to smokers, employers neglect this obligation, risk hurting vulnerable groups, and behave unethically. The same goes for imposing high penalties on smokers under the guise of providing wellness incentives.
We believe that employers should consider more constructive approaches than punishing smokers. In hiring decisions, they should focus on whether candidates meet the job requirements; then they should provide genuine support to employees who wish to quit smoking. And health care organizations in particular should show compassion for their workers. This approach may even be a win–win economic solution, since employees who feel supported will probably be more productive than will those who live in fear of penalties."
Whereas the next commentary "Conflicts and Compromises in Not Hiring Smokers", the authors conclude "We recognize that these hiring practices are controversial, reflecting a mix of intentions and offering a set of outcomes that may blend the bad with the good. We know that many companies will want merely to continue their current level of anti-tobacco efforts, but given the threats that tobacco presents to our communities and institutions, we believe it's time to climb another rung on the ladder,,," [toward the final rung "Eliminate Choice: Make Smoking Illegal"].
Read both free articles (click on the above links) and then return and present your opinion here. ..Maurice.
Graphic: From Google Images and modified by me with Picasa3
posted by Maurice Bernstein, M.D. @ 4:56:00 PM
9 comments
9 Comments:
I am not particularly sympathetic towards smokers. I do understand how addictive nicotine is, and I sympathize there. But there are products and help to quit. It is just beyond me to understand, given the costs of smoking (financial and health) why so many people continue.
Re. hiring smokers - the thing is, smokers bad habit does impact others. I'm sensitive to smoke - I don't like to have to run the gauntlet holding my breath and scurry past the cloud of smoke to get to the door.
And I'm sorry - smokers stink. Their breath stinks, their fingers stink, their hair stinks, their clothes stink. Those who smoke are used it, they do not realize how they smell. I certainly do not want a healthcare worker who makes me cough whenever they come near me.
I am sorry, I know this sounds harsh. But that's the impact smokers have on me. I sympathize and support all efforts of smokers to quit. But if they just want to continue, I'm afraid I want it far from me, and I'd probably feel that way as an employer.
Interesting also, as an aside, that smoking rates are higher among lower income people - as it is such an expensive habit.
While someone with cancer impacts insurance rates etc. they did not choose the cancer. Most people that engage in sports don't have big expensive injuries. I don't think any long term smokers escape some health impacts. As well as the impact (smell) on co-workers and clients.
TAM
TAM, how about firing an employee who smokes and doesn't appear to be attempting to quit? Also, short of firing, how about reducing his or her salary? ..Maurice.
Wow, that's a more difficult one.
Hard to say for me.
On the one hand, lots of people used to smoke, and they already had the job. So perhaps they should be "grandfathered" in?
On the other hand, especially if they are interacting with the public, and it could adversely impact the business, is it fair to give them an amount of time to quit?
I don't really know.
I do not agree with reducing their salary. Charging more for medical insurance, perhaps. But reducing the salary just seems like punishing someone. And I guess I don't believe in that.
Either they are appropriate for the job, in which case keep them. Or if not, don't. But they are still doing the job, therefore aren't worth less salary in my opinion.
TAM
TAM, I guess you find it ethically difficult to fire someone who was already hired but turns out to be a smoker..or are you thinking about discrimination in the workplace laws?
Should salary be fixed and not related to the employee's value to the employer and thus if the value is diminished as a nurse smelling of smoke in a hospital, there would be no lowering of salary even if he or she failed to stop smoking?
Is it more ethical ("the right thing to do") not to hire an individual who is in need of the job to live a decent life than to fire ("the ethically wrong thing to do") the same individual whom you already have hired because of a smoking habit? ..Maurice.
I guess I see a difference between someone who is already an employee, and hiring someone new.
If the company now changes the policy and doesn't want smokers, perhaps that is fair to not hire more smokers. But that criteria wasn't in place when they hired the current employee (presumably) so I have a hard time seeing it as fair to fire someone for something that was implicitly agreed to when they were hired.
If the policy is no smokers, and someone is hired who lied and turns out to be a smoker, I don't have a problem with firing them, as that was the agreement.
Perhaps similar on salary - if due to the smoking, they are less valuable to the company (can't deal with the public etc.) then I don't have a problem hiring smokers and non-smokers at different salaries. But to reduce the salary of someone already employed doesn't seem fair to me.
I guess, in my mind, it's stand by whatever agreement you made.
In being hired, you have to be appropriate for the job. If you're a bank manager, you probaby do not have hot pink hair and a ton of face piercings. If you choose to look like that, you are limiting what jobs you are appropriate for. If you choose to smoke, I think you are doing the same, more and more as society changes.
All that said, as society changes, and smoking is regarded in a worse light, maybe one day smokers will have to quit or be fired (and hopefully find jobs where it doesn't matter or quit smoking). But much as I dislike smoking, I can't really like that idea.
TAM
TAM
It's interesting to note that at most hospitals a blood
test determines if you are a tobacco user. At those
facilities all future applicants who smoke are not
eligible for employment, however, current smokers
within the organization pay $25.00 a pay period.
The medical campus becomes a smoke free
environment with employees walking a distance to
smoke off campus. At that point I can't help but
wonder who is taking care of their patients.
PT
PT, in answer to your question: "the non-smokers are taking care of their patients." The problem is that there is a disconnect in patient care by that "long walk" and time spent smoking and contemplating other issues. On the other hand, one may argue that it is usual (isn't it?) for nursing staff to take "breaks". I think the difference is that the routine non-smoking breaks would really take place within the hospital environment itself and the nurses would be likely taking the break on the ward, perhaps not very far from their patients. Leaving the hospital "smoke free" environment, I think, is a significant logistic/nursing care difference between one "break" and the other.
..Maurice.
Perhaps refusing to hire a smoker can be justified on the basis of the health risks of smoking and resulting higher health care costs to employers. What cannot be justified is refusing to hire a non-smoking nicotine user.
The 2007 report from the UK's Royal College of Physicians, "Harm Reduction in Nicotine Addiction: Helping Smokers Who Can't Quit", pointed out, "It appears increasingly probable that some smokers may experience very long-term, perhaps lifelong, disruption of brain function, mood and/or cognitive ability following smoking cessation. Such individuals may require similarly long-term treatment support or nicotine maintenance, and this may account for the sustained use of nicotine medications by some ex-smokers, many of whom report that their use is to enable them to maintain [smoking] abstinence."
A humane way of dealing with such people is to encourage them to switch to a low-risk source of nicotine. This practice is called Tobacco Harm Reduction (THR). The only product that has been studied for the long-term health effects of nicotine (separate from smoke) is smokeless tobacco (ST). Evidence was presented to the FDA showing that ST use does not increase the risk of any type of cancer and that if there is any increased risk of cardiovascular disease, it is minimal. It was this evidence that allowed the FDA to determine that long term use of NRTs (nicotine patches, gum, lozenges, inhalers, and nasal spray) would not be hazardous. The most recent alternative product is the electronic cigarette (e-cigarette) that delivers nicotine via a vapor rather than smoke.
PT commented many employers are administering a blood test and making their hiring decisions based on the result. The tests are also used to target employees for fines (supposedly to reimburse the employer for higher health costs). The blood test measures how much nicotine from any source has been consumed. Thus someone who used nicotine gum to quit smoking and continues to use the gum to avoid relapsing will be labeled a smoker. Someone who uses ST but has never smoked will be labeled a smoker. Someone who quit smoking altogether a couple of years ago by switching to an e-cigarette will be labeled a smoker. There is no excuse for this, when an exhaled carbon monoxide test, which is definitive for smoking, can be administered and costs no more than the blood test for nicotine.
Nicotine keeps conditions such as depression, anxiety, attention deficit disorder, and mild cognitive impairment under control so that the user can remain productive and functional. Ergo, I believe that it is a violation of the Americans with Disabilities Act to discriminate against nicotine users -- especially when nicotine users who don't smoke don't increase health insurance costs. Sadly, I think it is going to take a well-publicized lawsuit to stop this discriminatory practice.
Good point, VocalEK, regarding the difference in the methods of detecting "a smoker" and the error which can occur by nicotine detection. Hopefully PT will return here to react to your posting. ..Maurice.
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