Doctors argue that arbitrarily excluding smokers does little to solve the problem, and that this type of healthcare discrimination could spread to other unhealthy groups.

Rarely in the medical field will anyone defend smokers, but three doctors recently published a perspective paper in the New England Journal of Medicine in defense of smokers who are arbitrarily screened out of jobs.

The authors—Harald Schmidt, Ph.D., Kristin Voigt, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D.—stated that while the move is both symbolic and an effort to lower health insurance costs for non-smokers, it is hypocritical for healthcare organizations to care for the sick while limiting their hiring practices based on a single risk factor.

“Many patients are treated for illnesses to which their behavior has contributed, including chronic obstructive pulmonary disease (COPD), heart failure, diabetes, and infections spread through unprotected sex or other voluntary activities,” they wrote. “It is callous—and contradictory—for health care institutions devoted to caring for patients regardless of the causes of their illness to refuse to employ smokers.”

Twenty-one states allow businesses to arbitrarily deny employment to smokers, while the other 29 have legislation preventing it. Many healthcare organizations—including the Cleveland Clinic and Baylor Health Care System—and businesses like Alaska Airlines, Scotts Miracle-Gro, and Union Pacific Railroad, have polices about not hiring smokers. The World Health Organization stopped hiring smokers in 2008.

Canadian tech company Momentous Corp. gained some attention recently for its unwillingness to hire smokers and its stated policy, “We drink. We swear. We don’t f—ing smoke.”

Delray Beach, Fla., stopped hiring smokers for municipal work, citing an annual savings of $12,000 per year in insurance for each non-smoking employee hired.

The U.S. Centers for Disease Control and Prevention (CDC) states that cigarette smoking costs $193 billion per year—$97 billion in lost productivity and $96 billion in healthcare costs. Second-hand smoke costs an additional $10 billion.

However, if healthcare costs are the only consideration, why aren’t other groups also singled out for their unhealthy behavior?