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