New Article Argues that Hospitals Denying Employment to Smokers is Not Consistent with Principles of Medicine

In an article published online ahead of print in Academic Medicine, physicians Thomas Huddle, Stefan Kertesz, and Ryan Nash argue that policies by which hospitals or health care systems deny employment to smokers are inconsistent with the traditional values of medicine.

(See: Huddle T, Kertesz S, Nash R. Health care institutions should not exclude smokers from employment. Academic Medicine 2014; 89.)

Here is the crux of their argument:

"We suggest that smoker ban proponents are mistaken when they maintain that smoker bans in health care institutions uphold professional norms in those institutions. Health care workers are expected to foster their patients’ healthy behaviors through respectful alliances with them, a posture articulated in the study of motivational interviewing. But health does not stand above care among the norms of medical practice; in fact, the latter is more important. Health care workers exemplify an ethic of care, including care for those whose ill health might be their own doing. Although there may be a case for having patients “take responsibility” for their health at the level of purchasing insurance, we do not consider individuals’ responsibility for their illnesses as disqualifying them from receiving care. Nor should we. This stance, which does not allow a person’s bad choices to influence our responses to his or her needs, is utterly at odds with employee smoker bans, which assign the moral status of the activity to the actor and label both as unwelcome. These bans reflect a moralization of health, characteristic of late-20th-century middle and upper class life, in which virtuous health behaviors serve as a marker for a “secular state of grace.” Whatever the merits of this moralization, its manifestation in smoker bans seems incompatible with mercy, charity, and even—insofar as such bans diminish the employment prospects of the poor—with social justice."

The article concludes:

"In the case of smokers, health care institutions ought to hire them freely and then encourage them to quit smoking. The message actually conveyed by an employee smoker ban to smokers is unlikely to be one of an affirmation of health; it is far more likely to be received as a personal affront or rejection. Such a message is incompatible with who we are as physicians and health care professionals. We believe that an institutional identity allied to the profession of medicine should be sufficient to rule out employee smoker bans for such institutions."

The Rest of the Story

The authors of this important and sentinel piece provide a cogent argument against smoker hiring bans. They compellingly argue that such bans violate the values and principles of medicine itself, by which care is provided to all who seek it, and moral status is not conveyed on the basis of health status or behavior.

Indeed, the moralization of health is a disturbing trend and is perhaps the greatest threat posed by workplace smoker bans.