Beginning September 1, all applicants for jobs with the Cleveland Clinic - a health system that is Ohio's second largest employer - will be tested for cotinine and rejected for employment automatically if the test indicates that they smoke or use smokeless tobacco (article 1; article 2; article 3).
The non-hiring of smokers policy will apply to all Cleveland Clinic sites in Ohio and Florida, as well as to all vendors hired at these sites. The clinic has more than 36,000 employees. It now joins Medical Mutual and Scotts Miracle-Gro as a large Ohio company which refuses to hire smokers. The policy will apply only to new applicants.
According to the official new policy: "Beginning Sept. 1, the policy goes into full effect, and all applicants who test positive for cotinine will not be offered employment at Cleveland Clinic. This policy applies to all Cleveland Clinic campuses in Ohio and Florida (but not Canada). Applicants will be referred to a free tobacco cessation program paid for by Cleveland Clinic. After 90 days, those who have been successful in quitting will be encouraged to reapply."
The reason for this policy provided by Cleveland Clinic is as follows: "Cleveland Clinic has been a leader in preventative health and wellness. In 2005, we designated the entire health system smoke-free. Last fall, we supported the SmokeFreeOhio Initiative on ballots. Recently, trans fats were banned from all patient and cafeteria menus. Cleveland Clinic will join the World Health Organization, the American Cancer Society and more than 6,000 other employers in the United States who have chosen to advocate for healthier living. 'As a leading healthcare organization dedicated to fighting disease and advocating healthy living, our policies and procedures must reflect that commitment,' says Toby Cosgrove, M.D., President and CEO."
"As Cleveland Clinic helps move society from “sick” care to “health” care, it’s important to acknowledge these startling statistics: The treatment of chronic medical conditions comprises more than 75 percent of the nation’s $1.4 trillion medical expenditures. Chronic medical conditions account for 70 percent of all deaths in the United States. Smoking costs more than $75 billion annually in direct and indirect medical costs. These costs and statistics call for healthcare organizations to take the lead in promoting wellness and disease prevention, regardless of the tough choices that may be involved. By instituting this new hiring policy, Cleveland Clinic will play a role in reducing healthcare costs for patients, employers and the government by promoting prevention and wellness."
The Rest of the Story
Clearly, by its own reasoning, the Cleveland Clinic's policies and procedures do not reflect a commitment to advocating healthy living. While smoking may account for $75 billion in medical costs, obesity accounts for more than $78 billion (even more than smoking). Yet the Cleveland Clinic has not announced a policy to refuse to hire fat people. If the Cleveland Clinic were true to its word about adopting policies and procedures that reflect a consistent commitment to advocate healthy living, then surely they would institute a policy of refusing to hire people who are overweight or obese. As with smoking, such applicants could be referred to a weight loss program and encouraged to reapply after 90 days if they lose sufficient weight.
Similarly, the Cleveland Clinic doesn't appear to care about the alcohol problem that afflicts American society and causes a huge burden of chronic disease. While smokers need not apply, persons who drink too much alcohol are free to seek employment with this health system that considers itself a leader in "preventative" health and wellness. So are those who engage in unsafe sexual activities, eat far too much fat in their diets, consume high amounts of unhealthy trans-fats, or engage in a sedentary lifestyle and get absolutely no physical activity or exercise.
To be clear, what the Cleveland Clinic is doing is discriminating against smokers in employment. They are justifying this selective and targeted employment discrimination on the grounds that it is important to promote a healthy workforce. Yet they show no desire to actually promote a healthy workforce by making sure that prospective employees are actually healthy. They can be as unhealthy as they want to be, as long as they don't smoke.
Obesity - that's fine. Alcohol overuse - fine. An unhealthy diet - fine. High trans-fat intake - fine. High cholesterol intake - fine. No exercise at all - fine. The only thing that is not fine is smoking. You can't convince me that the Cleveland Clinic is solely motivated by a desire for a healthy workforce. Clearly, they don't give a particular damn about whether their new employees have a host of other health problems (which may be far more severe than smoking at their particular ages). They only care about whether they smoke or not.
Perhaps the Cleveland Clinic would argue that they do care about these other problems - that's why they have health and wellness programs at their facilities to address them. Great, then implement health and wellness programs to address smoking as well. You don't deal with these other health problems through corporate wellness programs and deal with smoking by throwing applicants' resumes in the trash can.
Sadly, the precise reasoning the Cleveland Clinic is using to support discrimination against smokers in employment also supports discrimination against obese and overweight people. If we are going to support the idea of excluding smokers from employment to save health care costs for employers and to promote a healthy workforce, then we must also support the idea of excluding fat people from employment.
If the Cleveland Clinic were taking a broad and consistent approach to hiring in terms of healthy lifestyles, and refusing to hire anyone who engages in a behavior that has serious long-term health implications, it would be one thing. Then I might take them seriously and believe that the health and economic concerns are really at the forefront of their action. But by discriminating only against smokers, I think they have exposed the true force beyond the policy: bigotry and intolerance of a large segment of the population whose personal and private lifestyle choices they are unwilling to accept.
I'm sorry, but employers have no business inside the homes of their employees, other than to ensure that they are not engaging in illegal behaviors or behaviors that directly impair their job performance. And employers certainly have no business getting inside the body fluids of their employees, except, again, to ensure that they are not using illegal substances. But when it comes to engaging in lawful behaviors in one's home that do not directly influence job performance, an employer has no business interfering with an employee's or potential employee's privacy.
Perhaps most disturbing is the degree to which the Cleveland Clinic appears willing to intrude into the privacy of employees' homes. I don't want my employer snooping around my house to see what I do in my own home on my own time. If they suspect me of illegal behavior and they want to pry on me, that's one thing. But if it's lawful behavior that's not in any way unprofessional, then they have no business controlling what I do in my home. And they have no business making employment decisions based on it.
This is what scares me most, because it suggests that anti-smoking groups have completely lost a sense of perspective. The only thing that matters is whether people smoke or not and how much we pay for smoking-related costs. We need to reduce smoking and these smoking-related costs at all cost. No matter how intrusive of our privacy, autonomy, or rights. There's nothing to stop us. Nothing to get in the way of our agenda.
The anti-smoking movement does not appear to understand or respect that what people do in their homes is their own business, as long as it is lawful and does not directly impair their job ability.
Even if the movement didn't respect the privacy and autonomy of individuals, it would still be more respectable in my eyes if it wanted to impose its intrusion systematically and consistently. So if these groups were calling on a workforce of non-smoking, physically active, thin (but not too thin), normocholesterolemic, non-hypertensive, non-hyperglycemic, and sexually non-promiscuous individuals, then I might believe that this is all motivated by a true concern for health and health care costs.
But the singling out of one particular risk factor suggests that there is something deeper going on, something beneath the surface. And I think what's underlying it is some sort of basic intolerance of smokers, and perhaps a desire to punish smokers and coerce them to change their behavior in a desired way.
Ohio needs a law to prevent this type of intrusion and discrimination. And it needs it now. As much as I hate to support the idea of government intervention to control this problem and protect people's privacy and rights, I don't see that the anti-smoking movement is going to back down.
This type of employment discrimination and bigotry is a terrible precedent, and it paves the way for even more serious discrimination. If we want to eliminate the most severe forms of discrimination from society, then I think we need to be concerned about the less egregious forms, which will otherwise open the door for, and pave the way for more serious breaches of personal rights, privacy, and autonomy.