Map of life expectancy at birth from Global Education Project.

Thursday, April 11, 2013

Hard questions

It's ethics week at the New England Journal of Medicine. Two questions get debated:

Is it ethical for employers to refuse to hire smokers? Pro here, and con here.

Should it be legal for physicians to assist in suicide of terminally ill people? Pro and con at the same URL.

I'm going to say that as far as disqualifying nicotine fiends from employment, I'm 100% agin' it. There are many telling arguments. First of all, where does it stop? Fat people? People who don't take their anti-hypertensives regularly? People who have more than 2 alcoholic beverages each day? People who don't eat five servings of fruits and vegetables? You get the idea. You need to somehow justify why smoking, among all unhealthy habits, is unique.

Second, it's an addiction. Many people think of addiction as a disease. That's debatable on semantic and philosophical grounds, which I won't go into here, but the point is, it's not really voluntary. Most smokers start as minors, in large part because tobacco companies snare their immature judgment with slick marketing campaigns. Then they find it very difficult to stop. (Most smokers want to quite.) Just mouthing the words "personal responsibility" is begging the question. (Yes, I used the phrase appropriately: it's assuming the consequent.)

Third, smokers are disproportionately to be lower income, lower educated, and non-white. So it just adds to the discrimination and disadvantages many people already face.

The pro arguments are basically three. Two are pretty much answerable in the same way. These are that other insurance ratepayers, particularly other employees of the company and the company itself, have to pay for their increased disease risk. Yes, but that's the whole point of insurance. See above regarding fat people etc. You could use that argument to refuse to hire people with HIV, or diabetes, or cancer. Good luck with that. The second argument, which is increased risk of absenteeism or shortened job tenure, is answerable in exactly the same way.

The third reason, mostly applicable to health care providers, is setting a good example for customers. See above, fatness. Obviously, it is 100% legitimate to forbid smoking on the premises, but that's a separate question.

What you should do is provide encouragement and assistance for smoking cessation.

As for physician-assisted suicide, I find that more difficult.

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