By Jacob Molyneux, senior editor
The Ethical Issues column in the June issue is called “The Ethics of Denying Smokers Employment in Health Care” (free until July 16). As in his previous columns, nurse–ethicist Doug Olsen models the thinking process of an ethicist, illuminating the fundamentals of ethical reasoning even as he tackles a specific ethical question.
Most positions we take on tough questions depend on a number of assumptions, both conscious and otherwise. In this article, Olsen does a great job identifying and then testing the assumptions that underlie such no-smokers hiring policies. Here are the main ones, as Olsen describes them:
- Personal responsibility applies to smoking—that is, the individual is responsible for the smoking behavior.
- There is a positive cost–benefit ratio in denying smokers employment.
- Patient care is improved by not having smokers on staff.
- Smokers can be reliably identified.
- Smokers are not being singled out—people with other equally unhealthy behaviors meeting the criteria on this list are treated in the same way.
- Refusing to employ smokers is good publicity for the hospital and therefore improves the hospital’s ability to fulfill its mission.
After considering the defensibility of each of these assumptions in turn, Olsen makes a distinction between what he calls “restrictive” and “caring” policies, and considers the potential effects of each on public perception when it comes to a hospital.
Does the author come down on either side of the debate? He leaves the answer to readers. Having read this article, you will be better equipped to rationally consider all sides of this question—and of other ethical questions as they arise, as they inevitably will. A podcast of a conversation with author Doug Olsen can be found on our “Behind the Article” podcasts page.