Lifestyle Discrimination

Nurses Activism

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Should lifestyle discrimination be legal ? With the rising cost of healthcare, companies are looking for ways to save money. Across the US, many companies, including hospitals, are refusing to hire employees who's lifestyle is deemed to be high risk.

Users of tobacco, though perfectly legal, are being told that they aren't entitled to have a job because they smoke or chew tobacco. And many supporters of this new type of discrimination are living very high risk lifestyles themselves. Although they may not yet be aware, companies know when they've stumbled on to something that increases their profits. Eventually, many other groups will be added to the list of unacceptable lifestyles, including those who are over-weight, drink alcohol, poor eating habits, etc. And with advancements in genetic testing and lifestyle screening, the practice of refusing to hire, refusing to insure, or denying many of the opportunities that were once equally available to all, might very well be the way of things to come in America.

How bad does the discrimination have to get before people will begin to recognize it for what it truly is, and take action to stop it?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

thread moved for best response

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Specializes in Dialysis.

it boggles the mind and scares me. I don't think it should preclude you from being hired, but I think that it should impact deductibles and benefits (don't flame me please!). I live clean-0 drinking, 0 smoking, only risky behavior is riding motorcycles. I eat healthy as I had bariatric surgery 5 years ago and chose to maintain healthy habits with exercise. I just don't think I should have to pay the price for others bad choices. I think we should ALL be held accountable for our choices. That is part of the problem with our country right now, no one wants to accept blame for mistakes, and wants everyone to pay the price for bad choices. It sounds harsh, but it's a reality that we all should start dealing with. Now, off my soapbox and to eat breakfast.....

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Specializes in CRNA, Finally retired.

Smokers=higher insurance premiums for employers, more sick time, etc. A no-brainer for employers.

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Specializes in Critical Care, Education.

As far as I know, Capitalism has always trumped Ethics in the US. Probably not going to change in my lifetime.

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While some risky lifestyle choices are legal and some are not, they're all entirely voluntary. How hypocritical is it for the nurse just in from a smoking break to counsel a COPDed to quit smoking? How can obese healthcare providers have any credibility in educating pts about weight reduction?

Health promotion is an essential function of competent nursing. I think it's totally fair to not hire employees who are poster children for "do as I say not as I do." They don't hire people with criminal records to be cops either. Certain professions have a higher standard of scrutiny. Sure smoking is legal but doubt we'll ever have a surgeon general who smokes. It's not discrimination, it's a refusal to promote hypocrisy.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

While i dont support banning the hire of tobacco users, I don't accept the OP slippery slope theory either.

Smoke lingers on the smoker and their clothes, & costs an estimated $6,000 per year to employers.

How do you feel about vaping? Nicotine vapor, but I believe its tobacco free

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Discrimination? Nah. Just good common sense.

1- Hospitals insure employees. Smokers are more likely to cost a lot more money. I am quite sure Greyhound "discriminates" against reckless drivers. Not hiring smokers is just good math. Maybe if the supply/demand ratio changes a bit in the future, hospitals will resume the added expense of hiring smokers.

2- Smoking is a real health risk. I'm not making this up- You can even Google it. I smell smoke on my smoking co-workers, as I am sure my patients do. If, the hospital feels that part of it's mission is promoting health, than there is some logic to not hiring smokers.

All of this has nothing to do with the respect I have for some of my tobacco loving co-workers. It has to do with the right of an employer to exercise judgement in hiring.

Slippery slope? Maybe. Obesity could be next. I am pretty sure it is legal to to require being a positive role model in certain jobs. For example, probably legal for a rehab program not to hire a counselor who drinks heavily, despite the legality of heavy drinking.

Lets say I am an HR manager. I have a choice of hiring smokers or non smokers. Can anybody make a good case that I should hire smokers?

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While I think all of you make good points, the case I am making is simply this. Technology is being exploited to discriminate against the legal activities of citizens in their off work time. In this case, its medical technology. And those of you who think that you are safe from this technology are sadly mistaken. perhaps not you, but sooner or later it will be someone close to you, someone you care about who can't get hired because there are test available to tell if they have smoked even once in the last 90 days, or their cholesterol is too high, or obese, etc... you can call that a slippery slope if you like, but history has proven one thing, if the technology exist, someone will find a way to exploit that technology.

The most foolish concept I have every heard of is that you can lower the cost of healthcare by excluding the unhealthy portion of the people from participating. Yet that is exactly the goal of every health insurance company.

No one seems to take notice of the average surgeon who earns $600,000 a year, they truly believe that health care cost so much because people aren't treating their bodies like a freaking holy temple.

I've got news for all of you, there has never been a shred of proof that a smoker who dies at 60 years old will cost healthcare more dollars than someone who slowly dies at 90 years old. 30 years worth of medications and doctor visits really adds up ya know! Do you have any idea how much it cost to keep that 90 year old person in a retirement home for 15 years with round the clock care?

I mean, why in the heck are we not refusing to hire people who ride motorcycles? Why? because there isn't any true logic involved. It's simply a scam for quick profits, a scam, a fictitious story that the insurance companies knew all of the non smokers in America would believe. Give them someone to to blame, while the real crooks rob them blind.

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Nurse Lisa-

Congrats on your weight loss and maintaining a smoke and alcohol free lifestyle. I do have one concern, though. Because of your gastric bypass surgery, you have a greater risk of complications occurring with nutrient absorption, scar tissue, etc, than someone who did not have that surgery. So comparatively, you pose an increased risk and therefore should pay higher deductibles and copays now, since there is a chance that could happen in the future. Also, maybe you should be looked at as a hiring risk because of this issue. You would certainly cost your employer lots of money if you had to be out on STDB while you recovered from a complication. And then there is the motorcycle riding. People who ride motorcycles should be held responsible for their risky choices, too. I think you should have to pay part of my insurance bill because I don’t ride motorcycles.

I’m being facetious of course. The point is, this debate is more complicated than talking about taking responsibility for your actions. I get particularly perturbed about the obesity issue because it’s not the same thing as smoking, drinking, even riding motorcycles. It’s not black and white. You don’t have to drink alcohol or smoke cigarettes, but you DO have to eat food. There are a million little choices and a bunch of other intervening factors, many of which are completely out of an individual’s control, that determine if you are overweight or normal weight, obese, or thin. And no one ever talks about the difference between a heavy but active, strong, and productive obese person, and the obese person who is functionally and legally disabled because of their weight. It’s a big difference. But if it came down to discrimination, you can bet it would all get lumped together based on BMI or some such easily calculable number.

Furthermore, one could argue at length as to what constitutes a healthy lifestyle. Of course we all agree on eating right, exercising, maintaining a healthy weight, wearing your seatbelt, not smoking, blah, blah blah. But what about emotional health? Maybe we shouldn’t hire people who struggle with depression or anxiety because of the increased cost they pose on the system. What about people who use antiperspirant, eat non-organic meat, engage in risky sexual behaviors, get pregnant over the age of 35? Those are all behavior choices associated with potential disease processes or complications that lead to higher healthcare costs.

Just something to think about.

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Specializes in FNP, ONP.

"How bad does the discrimination have to get before people will begin to recognize it for what it truly is, and take action to stop it?"

Speaking for myself, it would have to be so bad as to include class discrimination based on race/ethnicity, gender (including gender identification), sexual orientation, disability or religion. Modifiable health risk factors as a basis for making hiring decisions are not bothersome to me. I would not knowingly hire an alcoholic, even though alcohol consumption is legal and I consume alcohol occasionally myself. I don't hire tobacco users. I don't consciously discriminate against obese people, but I hired a slim, highly physically fit woman. She could still have a genetic triglyeridemia or be BRCA+for all I know. Those of us in a position to hire make the best decisions we can based on the data available. In this case, even if my Nurse had been BRCA+, I'd still have hired her because she was a good fit for me and for the office. I would not have hired her if she smoked, because she would not have been a good fit. Capiche? I would not have hired her if we knew for a fact she was an alcoholic because, well do I really need to explain, lol?

I don't care if an employee has a diagnosis of major depression (outside of the fact that I generally do care about them as people) unless it causes them to miss unacceptable amounts of work. That is usually easily checked into by the background investigation. People with excessive call-ins are typically "not for rehire" at previous jobs. Otherwise great employees who have a behavioral health diagnosis and needed FMLA a few years ago, took it, recovered and came back to work at their former level of excellence are worth investing in, so I don't think their diagnosis is any more significant than someone with an elevated LDL.

The fact of the matter is, most of the things you chicken littles are worried about can be changed. If you are worried about it, change it; lose weight, stop smoking, whatever. If you don't take steps to help yourself, you have no one else to blame.

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Respectfully, I don't consider myself a chicken little at all. And I'm not blaming anyone for anything either. The point I was trying to make was that it is assinine, unfair, and kind of random to make hiring decisions based solely on a person's weight. There are fat nurses who are smarter, work harder, and are better nurses that thin ones. To say they should not be hired because they are "not setting a good example for patients" is ridiculous. To say that they should not be hired because they do not fit in with other physically fit and attractive employees is short sighted and mean spirited. That is discrimination, plain and simple. Yet, because you insist a person's weight is "modifiable," you absolve yourself of such.

What about religion? That's modifiable right? So should employers only hire Christians? If you're not a Christian, you can always change, right? Maybe they should just include a few questions on the HCAPS survey about what type of attributes patients prefer in their nurses, and guide hiring decisions that way. After all, like a lot of people on this thread have asserted, it's all about dollars and "sense." Maybe if the hospital hired only attractive, thin, fit, Christian, extroverted nurses with great teeth, scores and reimbursement would go through the roof? And those are all MODIFIABLE traits! Just get some plastic surgery, dental work, exercise, go to church, read the bible and pray. Take some Zoloft, slap on a smile, and blam, you are HIRED!!

No one dares discriminate based on race or ethnicity. At least they won't admit it if they do. No one dares discriminate based on age or religion, sexual orientation, or disability, or at least they won't admit if if they do. But there's this undercurrent of hate toward fat people that somehow, people think is OK. I call BS.

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