The Cleveland Clinic: Unethical By Its Own Standards

By its own standards, the Cleveland Clinic is acting unethically by supporting behavior that ultimately leads to death.

How is the Cleveland Clinic supporting behavior that leads to death?

Well, it's doing it in two ways:

1. By continuing to employ smokers, which increases health care costs, threatening our "sustainability as a nation."

2. By continuing to employ overweight individuals, which drives up health care costs, threatening our "sustainability as a nation."

The Rest of the Story

It is not me who opined that hiring employees who exhibit unhealthy behaviors is unethical. It is the Cleveland Clinic! In an op-ed piece, the physician who chairs the Wellness Institute at the Cleveland Clinic wrote:

"Is it ethical for employers to hire smokers? The practice fosters ill health and makes America less competitive in an international marketplace. The expense of healthcare in the United States represents more than 18 percent of the gross domestic product, more than in any other country. It threatens our sustainability as a nation, squeezing out education and defense. Therefore, we must do everything we can to bring down costs while improving quality. Tobacco use accounts for one in every five deaths each year in the U.S.To us, supporting a habit that ultimately leads to death would be unethical. In 2006, we began offering free smoking cessation to our employees; the following year we offered the same throughout Northeast Ohio. In 2008, we stopped hiring smokers, a natural progression."

So the Cleveland Clinic itself apparently believes that it is unethical to hire smokers. Well, then, the Cleveland Clinic is, by its own admission, engaging in unethical behavior because it employs smokers. In fact, 6% of its workforce smokes. Why is the Cleveland Clinic continuing to engage in this unethical behavior? Sure, the Cleveland Clinic has stopped hiring new employees who smoke, but ethics does not know the difference between an existing employee and a new one. If it is unethical to employ a smoker, then it is unethical to employ a smoker. There is nothing stopping the Cleveland Clinic from firing existing smokers who do not quit within a reasonable amount of time.

Moreover, by its own admission, the Cleveland Clinic is unethical in supporting another behavior that leads to death: overeating and under-exercising. Overweight and obesity are severe health risks that lead to billions of dollars in health care costs. To be sure, obesity is driving up health care costs in the same way as smoking. Some estimates put the costs of obesity as rivaling those of smoking.

So why is the Cleveland Clinic supporting these unhealthy behaviors which can lead to death by continuing to employ overweight and obese individuals?

While businesses that refuse to hire smokers can make a legitimate argument that they need to reduce health care costs. if they implement smoker-free policies for this reason then they are simply engaging in discrimination and bigotry. But the Cleveland Clinic is not just engaging in discrimination and bigotry. It is also engaging in the basest form of hypocrisy: telling the world that it has higher ethical standards than most, but not actually living up to the ethical standards it espouses.

The Cleveland Clinic tells us that it is unethical to employ smokers, but then it goes ahead and continues to employ smokers. The Cleveland Clinic tells us that hiring people who engage in unhealthy behavior is unethical, and then it goes ahead and continues to hire people who overeat and under-exercise to the point that their obesity threatens their health and lives.

The Cleveland Clinic is not just serving as a model for employment discrimination and bigotry. It is serving as a model for hypocrisy and political cowardice. They are not even willing to stand up for what they say they believe in.

This is politics, not public health.

The appropriate way for employers to deal with problems such as smoking and obesity is not to discriminate against smokers or overweight individuals in their hiring practices, but to offer comprehensive employee health and wellness programs with state-of-the-art initiatives to promote healthy behavior.

Worksite health promotion is a central aspect of public health. Employment discrimination is not.