by Jacob M. Appel MD, JD May 13, 2022

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel's 2019 book, Who Says You're Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

A private hospital is concerned that smoking and obesity among its employees are driving up its healthcare costs. The hospital board enacts a new employment policy: all new hires must refrain from smoking and must maintain a healthy body weight.

The facility plans to conduct random urine tests twice each year to screen for nicotine and to conduct annual weigh-ins. All employees found in violation of hospital policy will be given one warning and an opportunity to engage in smoking-cessation and weight-loss programs. If they again fail to meet either standard, they will be dismissed.

Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

Check out some of our past Ethics Consult cases:

Who Decides if Child Is 'Dead?'

Let Patient Pray Pneumonia Away?

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