Do's and don't's in fasting (Medical related)...a note for doctors

As Ramadhan approaching us, it is good to revise back what we can or cannot do/ take when we are fasting. Especially for doctors, especially Muslim doctors...you should know how to advise your patients with regards what are the things which invalidate and which do not invalidate patient's fasting status.

I am going to update or rather share some of the things I have learned during my weekend course on 'The Fiqh of Zakat and Ramadhan' by Sheikh Asim Al-Hakeem. Basically I'll try to just highlight things that invalidate and do not invalidate one's fasting related to medical practice.

Invalidate the Fast

• Anything that is similar to eating and drinking will break the fast. This include:

1. Transfusion of blood to one who is fasting- such as if he bleeds heavily and is given blood transfusion. This invalidates the fast because blood is formed from food and drinks.
2. Receiving via a needle (as in the case of a drip) nourishing substances which take the place of food and drink, because this is the same as food and drink (Shaykh ibn Uthaymin, Majalis Shahr Ramadan, p 70). This is like giving IVD either plain normal saline/ Dextrose solution which can rehydrate and nourish the patient.

In regards to injections which do not replace food and drink, but rather are administered for the purpose of medical treatment (eg: antibiotics or insulin), or are given to energize the body, or for the purpose of vaccinations, these do not affect the fast, whether they are intravenous or intramuscular injected into a vein or a muscle) (Fatawa Muhammad ibn Ibrahim, 4/189)

Renal dialysis, in which blood is extracted, cleaned and then returned to the body with the addition of chemical substances, is regarded as invalidating the fast (Fatawa al-Lajnah al-Da'imah)

• Intentional vomiting

Abu Hurayrah r.a narrated: 'Whoever intentionally vomits must make up (his fast) and whoever was overcome by vomit does not have to make it up' (Abu Dawud, al Tharmidhi, and ibn Majah; authenticated by al-Albani)

Therefore, if vomit comes out without one's choice, there is no harm in that, and the fast is not broken. However, if he intentionally vomits by putting his fingers in his throat, by looking at something horrible in order to induce vomit, smeeling something horrible in order to vomit, or any other means of intentionally vomiting.

• Cupping (Bekam)

This is an issue of dispute. 

There is a long difference of opinion on this matter and the stronger of the two views seems to be that cupping does not break the fast. 

However, in either case, one should avoid doing it.

•             Menstruation or post-natal bleeding

‘Is it not the case that when she gets her period, she does not pray or fast?’ (al-Bukhari)

-When a woman sees the blood of her period or nifas, her fast becomes invalid even if it is a few seconds before sunset.

-If a woman feels that her period has started but no blood comes out until after sunset, her fast is still valid.

-If the bleeding of a woman who is menstruating or in nifas ceases at night and has the intention of fasting, and then dawn comes before she does ghusl, her fast is valid by the consensus of the scholars.

Hormone tablets:

A woman should avoid taking medicine that prevents her monthly cycle and should accept what Allah has decreed for her: to abstain from fasting during her period and to make up those days later. This is what the mother of believers and the female companions used to do. If a woman does take pills, however, and her period stops as a result, she can fast and her fast is acceptable.

Matters That DO NOT Invalidate the Fast

• ·      Enema, eyedrops, eardrops tooth extraction and treatment of injuries do not invalidate the fast if nothing goes down to the throat.
• ·      Medical tablets that are placed under the tongue (Sublingual), so long as you avoid swallowing any residue.
• ·      Insertion of anything into the vagina such as pessaries, or a speculum, or a doctor’s fingers for the purpose of medical examination.
• ·      Insertion of medical instruments or IUD into the womb.
• ·      Anything that enters the urinary tract of a male or female, such as a catheter tube, or medical scopes, or opaque dyes inserted for the purpose of x-rays, or medicine.
• ·      Fillings, extractions or cleaning of the teeth, whether with siwak or toothbrush, so long as you avoid swallowing anything that reaches the throat.
• ·      Rinsing the mouth, gargling, sprays etc. so long as you avoid swallowing anything that reaches the throat.
• ·      Oxygen or anaesthetic gases.
• ·      Anything that may enter the body via absorption through skin, such as cream, poultices, etc.
• ·      Insertion of an intravenous line through the veins for diagnostic imaging or treatment.
• ·      Insertion of a scope through the stomach wall to examine the intestine by means of a surgical operation (laparoscopy).
• ·      Taking samples from the liver or any other part of the body, so long as that is not accompanied by administration of solutions.
• ·      Endoscopy, as long as that is not accompanied by administration of solutions or other substances
• ·      Introduction of any medical instruments or materials to the brain or spinal column.

*** Hope these will clear some of our doubt and will be helpful for doctors to give advice to the patients.

***There are a lot more issues related to medical conditions which I will update later InsyaAllah

Man: Saint or Sinner

"Those who, when they commit a gross indecency or wrong themselves, remember God and pray for the forgiveness of their sins- for who but God can forgive sins? - and do not knowingly persist in doing the wrong they may have done. These shall have the reward of forgiveness by their Lord, and gardens underneath which rivers flow, where they shall abide. Excellent is the reward for those who labour (well)"- Ali Imran (Verses 135-136)

Another quality of the God-fearing is highlighted here. They are those who seek forgiveness whenever they slip into sin and make sure of not knowingly disobeying God's orders. How compassionate this religion is. Before He calls on people to be compassionate to one another, God, limitless is He in His glory, shows them one aspect of His own compassion of which they themselves are the recipients, so that they may learn.

In Islamic terminology, the God-fearing are among the elite of believers. God's compassion and mercy, however, include among them those who remember God after committing a gross indecency or who wrong themselves and pray to Him for forgiveness of their sins. The term "gross indecency" includes the most ghastly of all sins. This religion of ours, however, is so tolerant that it neither considers those who sink to its depth as outcasts, nor deprives them of God's mercy. They are not given the bottom rank among the believers. Rather, they are elevated to the rank of the elite, the God-fearing, on one condition only. That condition is that they should remember God and pray to Him to forgive their sins, that they should not persist with their wrongdoing, knowing that it is sinful, and that they should not unashamedly boast about the sin they have committed. In other words, they should remain within the framework of servitude to God and ultimate submission to Him. By doing so, they remain entitled to His forgiveness, mercy and bounty.

Islam recognises man's weakness. Man may always succumb to his physical desires which may bring him down to the depths of gross indecency. His lust, ambitions or temptations may cause him to lose control and drive him to disobedience of God. Recognising this weakness in man, Islam does not adopt harsh punishments, rejecting a sinner altogether and depriving him of God's mercy when he wrongs himself by committing a gross indecency. In the Islamic view there is something important to add to his credit which is the fact that the light of faith has not been put out altogether in his soul. His heart is not totally hardened, his relationship with God is still alive and he knows that he is merely a servant who slips and makes mistakes, and that he has Lord who forgives. This weak, sinful creature, then remains essentially good. He clings to his bond with God and lie does not sever it. He may, then, slip as many times as his weakness imposes on him. Eventually, he will get there, as long as he holds to his bond with God and keeps the light of faith within him. He must always remember God, pray to Him for forgiveness and acknowledge his submission to Him and refrain from boasting about his sins.

Never does Islam slam the door in the face of a weak sinner leaving him lost in the wilderness. Never does it let him feel permanently rejected, afraid to turn back. On the contrary, it holds for him the prospect of forgiveness. It shows him the way and holds his trembling hand, steadying him and giving him the light he needs to return to his secure refuge. It only required one thing of him, namely, that his heart and soul are not hardened so as to make him forget God. As long as he remembers God and keeps alive in his conscience the voice of guidance and maintains in his heart the yearning for God's grace, then light will shine again in his soul and the seed of faith will burst forth with a new plant.

When your misbehaving son has run away knows that nothing awaits him at home except flogging, he will never return. But if he knows that there is also a tender hand which will pat his shoulder when he apologises for his misdeeds and which excuses him when he asks for pardon, he will certainly come back.

Islam knows that side by side with man's weakness and carnal desires there exist strength and sublime aspirations. For this reason, Islam is sympathetic to man in his moment of weakness, places him back on his way to a higher horizon, as long as he remembers God and does not knowingly persist with his wrongdoing. The Prophet says: "He who prays for forgiveness does not persist with his sin, even if he commits it 70 times a day." (Related by Abu Dawud and Al-Tirmidhi). In doing so, Islam does not advocate complacency, nor does it praises the one who frequently slips or who describes sinful action as beautiful, as those who call themselves "realists" do. It simply overlooks such errors in order to awaken both hope and a sense of shame within man. Forgiveness by God, the only One to forgive sins, does not lead to complacency; it fills the sinner with shame. Only those who persist and pay no heed remain outcast. Thus, Islam combines its call to man to aspire to a higher horizon with its mercy and compassion, knowing man's weakness and capability. It ensures that the door of hope is always open in front of man as it motivates him to exert his utmost in his aspiration towards the sublime.

What is the reward of those God-fearing people? " These shall have the reward of forgiveness by their Lord, and gardens underneath which rivers flow, where they shall abide. Excellent is the reward for those who labour (well)"- Ali Imran verses 136

When people pray for forgiveness of their sins, and spend their money in times of prosperity and hardship, and when they control their anger and forgive others, they do not take a negative attitude. Indeed, they are good workers.

"Excellent is the reward for those who labour well". That reward is forgiveness and Paradise. The work of those people has two aspects: an internal one in their own soul and an external one in practical life. Both are fruitful. 

**Source from the book of 'Under the Shade of AlQuran- Vol 2'