Berman and Crane contend that smoker hiring bans at academic health centers (AHCs) advance AHCs’ public health mission (which, they say, is as important as their health care mission) and express care for prospective employees. They mistake both AHC missions and the “care” in health care. While AHCs often consider public health in their decision making, health care is their central activity. AHCs cannot advance public health in any way comparable to their provision of health care—not merely because public health goals pursued coercively may offend our professional identity as carers, but because public health is never merely about health. Public health decisions implicate the relative value of health and other important civic priorities, such as the freedom to engage in legal activities in spite of their deleterious effects. Health professionals rightly disapprove of smoking, overeating (112,000 deaths/year),1 distracted driving (3,328 deaths/year),2 sexual promiscuity ($17 billion in health care costs/year),3 and overconsumption of sweetened drinks. It does not follow that we should express that disapproval of our neighbors’ unhealthy activities by depriving them of employment—unless our identity as health professionals implies not only valuing health, but conditioning our willingness to work with our neighbors on their conformity to our value for health.
Berman and Crane suggest that smokers are not good employees. Of course those who cannot do the job ought not to be hired. But the suggestion that smokers, in the aggregate, perform less well than nonsmokers, even if true (which we contested in our article), would not justify a judgment that no smoker can adequately perform simply because he or she smokes.
Berman and Crane suggest that smoker hiring bans take aim at smoking rather than the smoker. From the perspective of those banning, they are likely correct. Those on the receiving end may, however, see it differently. Smoker hiring bans certainly “provid[e] important motivation” to quit, for some. But spurs to motivation take diverse forms. Not all are equally compatible with an ethic of care, which we argue is primary for AHCs and for health care providers more generally. As care requires acceptance in spite of flaws, rather than rejection on account of them, we suggest that AHCs should lead in caring as they encourage health by hiring smokers and helping them quit.
Thomas S. Huddle, MD, PhD
Professor of medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; [email protected]
Stefan G. Kertesz, MD, MSc
Associate professor of medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Ryan R. Nash, MD, MA
Hagop S. Mekhjian, MD, Chair in Medical Ethics and Professionalism, Center for Bioethics and Medical Humanities, Ohio State University College of Medicine, Columbus, Ohio.
References
1. Centers for Disease Control and Prevention. . Frequently asked questions about calculating obesity-related risk.
http://www.cdc.gov/PDF/Frequently_Asked_Questions_About_Calculating_Obesity-Related_risk.pdf. Accessed October 30, 2014
2. National Highway Traffic Safety Administration; U.S. Department of Transportation. . Key facts and statistics. Distraction.gov: Official US Government Website for Distracted Driving.
http://www.distraction.gov/content/get-the-facts/facts-and-statistics.html. Accessed October 30, 2014
3. Centers for Disease Control and Prevention. . STD trends in the United States: 2010 national data for gonorrhea, chlamydia, and syphilis.
http://www.cdc.gov/std/stats10/trends.htm. Accessed October 30, 2014
