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Health Care Institutions Should Not Exclude Smokers From Employment

Huddle, Thomas S. MD, PhD; Kertesz, Stefan G. MD, MSc; Nash, Ryan R. MD, MA

doi: 10.1097/ACM.0000000000000247

Some health care institutions, including academic health centers, have adopted policies excluding smokers from employment. Claims advanced on behalf of these policies include financial savings from reduced health costs and absenteeism as well as advantages consonant with their message of healthy living. The authors suggest that the institutional savings from these policies are speculative and unproven. Also, in settings where large medical schools operate, it is likely to be the poor, including members of minority groups, who, under an employee smoker ban, will lose the opportunity to work for an employer that offers health insurance and other benefits. In response to the incentives created by such bans, some will quit smoking, but most will not. Thus, at the community level, employee smoker bans are more likely to be harmful than beneficial.

Although private businesses may rightly choose not to hire smokers in the 19 states where such policies are legal, health care institutions, including academic health centers, should consider hiring choices in light of the values they profess. The traditional values of medicine include service to all persons in need, even when illness results from addiction or unsafe behavior. Secular academic communities require a shared dedication to discovery without requiring strict conformity of private behavior or belief. The authors conclude that for health care institutions, policies of hiring smokers and helping them to quit are both prudent and expressive of the norms of medical care, such as inclusion, compassion, and fellowship, that academic health professionals seek to honor.

Dr. Huddle is professor of medicine, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, Alabama.

Dr. Kertesz is associate professor of medicine, Birmingham VA Medical Center and University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

Dr. Nash is Hagop Mekhjian Chair in Medical Ethics and Professionalism and director, Ohio State University Center for Bioethics, Columbus, Ohio.

Editor’s Note: A commentary by J.M. Samet, H.L. Wipfli, and S. Gruskin appears on pages 837–839.

Funding/Support: None reported.

Other disclosures: None of the authors have personal commercial interests in companies that sell tobacco or tobacco control products. Dr. Kertesz serves unpaid on the board of directors of the Albert Schweitzer Fellowship, a nonprofit service organization.

Ethical approval: Reported as not applicable.

Disclaimer: Opinions expressed in this article are those of the authors and do not reflect opinions or positions of the U.S. government or the Department of Veterans Affairs.

Correspondence should be addressed to Dr. Huddle, FOT 720, 1530 3rd Ave. S., Birmingham, AL 35294; e-mail:

© 2014 by the Association of American Medical Colleges