Written by: Leah Jeunnette, Ph.D.(c)

Effective July 1, 2013, University of Pennsylvania Health System has taken the steps to no longer hire tobacco users. The Penn Health system defends its decision based upon the effort to reduce the cost of healthcare benefits. While current employees will be grandfathered in, new employees will be screened for tobacco use.

Penn Health will also offer free smoking cessation classes and nicotine replacement therapy for employees as well. Current staff and their families will pay higher premiums for the healthcare benefit if they are not enrolled in either of the two programs.

This is not the first time a health system has put this plan into place. In 2007, the Cleveland Clinic introduced their own nonsmoking hiring policy. Bon Secours Virginia Health System made the move in 2009. Across the country, other companies have done the same including American Airlines. In response to this smoking ban, many smokers believe they are being marginalized and even discriminated against. In fact, the ACLU has lobbied for smokers’ rights, which has led to 29 states and the District of Columbia to passing laws that protect smokers’ rights.

The debate over smokers’ rights will continue as some states pass laws to protect the rights, while others have companies that ban hiring smokers. While there is a legal debate, there is also a bioethics debate.

Smoking is a public health issue. Public health ethics differs from other areas of bioethics, because the traditional methodology and theories do not directly translate from clinical ethics to public health ethics. One of the most important and chiefly discussed ethical values is autonomy.  Autonomy is always given priority, but the decision should never cause harm to the individual or others. Smoking has been proven over many decades to cause direct harm to individuals and secondhand smoke is just as harmful. According to the CDC, every year 443,000 premature deaths and $193 billion in health bills and lost productivity are due to smoking and secondhand smoke.

Does this mean that it is ethical to override an individual’s autonomous choice to smoke? Not necessarily. In the case of the new rules for Penn Health, current employees that do smoke are not required to quit, but are offered free cessation or nicotine replacement therapy. In addition, they are subject to higher premiums for the healthcare benefits.  If the new employees are also willing to take on higher premiums because they are smokers, why shouldn’t the health system hire them? Wouldn’t it be better to hire the most qualified individual, rather than the second best who does not smoke?

Public health ethics also has a responsibility to promote health, and that includes finding ways to reduce the cost of health care. By companies taking a stand against smoking, they are promoting health and adding to a culture of health. Health systems especially have a responsibility to promote health, since that is their business, and stopping the use of tobacco is one of the simplest ways. At the same time, non-smokers should not be subjected to secondhand smoke. Additionally, the overall health premiums are increasing to cover the increase in cost due to smokers’ health bills. Non-smokers should not have to cover that increase.

As stated before, this debate is not going to stop. As some states move to pass laws to protect smokers’ rights and companies in other states move to prohibit hiring tobacco users, the debate is going to come to a head at some point in the legal system. Until then, consider the ethical issues at play in this public health debate.

To read all information regarding this new plan, visit the following website through Penn Health:

http://www.pennmedicine.org/careers/working-at-penn-medicine/tobacco-free.html