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Medical Questions Pertaining to Fasting
Author : Dr. Nidal Sultan
Date Added : 27-05-2015

All  perfect praise be to Allah, The Lord of The Worlds; and may His blessings and peace be upon our Prophet Mohammad and upon all his Family and Companions.

A Muslim may have to visit a clinic during the day time of Ramadan to undergo a medical examination or a surgery, or to take a medication. He/she would want to know how these matters affect his/her fast in terms of validity and invalidity so as to avoid matters that invalidate fast as much as possible, and to know the ruling of Sharia which applies to their situation, such as abstaining from food, making up missed fasts, and paying a ransom in case  fast was considered invalid. The following is a set of medical questions pertaining to fasting people, divided according to the different clinics. We beseech Allah to favor all people with good health and cure all patients.

First :Dental Clinic

What is the ruling on using tooth paste, gum-wash, and gargling medications during the day time of  Ramadan  ?

It is discouraged to use any of the above items during the day time of  Ramadan for fear that some of it may reach the coelom-even unintentionally- and invalidate fast. However, if nothing is swallowed, then the fast is valid.

Is it permissible to remove a tooth, fill it, and take out the nerve during the day time of Ramadan ?

Undergoing such treatments  during the day time of Ramadan doesn`t invalidate fasting, but swallowing anything during the treatment invalidates the fast of that day; however, the person in question should continue fasting for the rest of that day, and make up for it after Ramadan. Therefore, it is preferable to undergo such treatment during the night, or after Ramadan.

What is the ruling on the blood coming out of a person`s mouth and gum during the day time of Ramadan?

When a person`s gum bleeds during the day time of  Ramadan, he must spit out the blood until the saliva becomes clean i.e. until the bleeding stops. Next, he/she should  rinse his/her  mouth afterwards repeatedly. If some blood or water reached the coelom unintentionally,  nothing is due on him. Repeated gargling is intended here to cleanse the mouth from impurity caused by the blood.

Second: ENT Clinic

Does using nose and ear drops during the day time of Ramadan invalidate fasting ?

Using ear and nose drops invalidates fasting since they are open outlets to the coelom, and because the interior of the ear is a ceolom as stated by the Shafite scholars.

Does  bleeding from the nose during the day time of  Ramadan render fasting  void ?

The blood coming out of the nose during the day time of Ramadan doesn`t invalidate fasting unless some of it reaches the coelom, or  is intentionally swallowed, then the fasting of that day is void, and that person should  continue fasting for the rest of that day out of respect for the sanctity of Ramadan, and he should make up for it after Ramadan.

Third: Eyes Clinic

What is the ruling on using eye drops, ointment, and Kohl while fasting ?

Eye drops do not invalidate fast even if one feels their taste in the throat because the eye isn`t an open outlet to the coelom, rather, it is a narrow canal. Our righteous predecessors used to apply Kohl(cosmetic powder used in the East to darken the eyelids) while fasting. Also, applying eye ointment doesn`t invalidate fast.

Fourth: Respiratory and Thoracic Diseases Clinic

What is the ruling on using an inhaler by patients suffering from asthma ?

 Inhalations through the nose, or the mouth invalidate fasting because the medication they contain is meant to reach the lungs which are part of the coelom. Therefore, the fast of  the one who is obliged to use an inhaler during the day time of some Ramadan days is considered invalid. However, he should continue fasting for the rest of each of these days out of respect, and make up for them after Ramadan. Whereas, one who uses it on regular basis should keep doing so during the day time of Ramdan, but he/she should remain fasting for the rest of each day, and feed one needy Muslim for each missed day. Moreover, he doesn’t have to make up for the missed fasts.

What is the ruling on using snuff i.e. inhaling medicines, foods etc. through the nose at day time of  Ramadan  ?

Using snuff during the day time of Ramadan  renders fasting void because it is a solution inhaled through the lungs which are part of the coelom, and whoever uses it should abstain from matters that invalidate fasting for the rest of that day and make up for it after Ramadan. However, if only the scent of that material reaches the coelom, then it doesn`t invalidate fasting.

Does using a respirator at the day time of Ramadan render fasting of that day void ?                        Using a respirator during the day time of Ramadan  doesn`t invalidate fasting because oxygen is a mass-free gas. However, if therapeutic mass-based substances were added to the oxygen, then using it during the day time of Ramadan breaks fast of that day because it enters the coelom from a regular outlet.

 Fifth: Internal Medicine Clinic

Question: What is the ruling on the fast of persons who suffer from diabetes, heart diseases, blood pressure, kidney diseases and ulcer?

Those who are totally unable to fast all over the year should break fast and pay a ransom, which is giving a Mud(600 grams) of wheat or rice, or the price of that amount to a needy Muslim against each missed day, and they don`t have to make up for the missed fasts. However, those who are able to fast during certain days of Ramadan, but aren`t able to do so during other days should observe fast whenever they could, but should make up for the missed days, and no ransom is due on them. Those who aren`t able to fast during the long summer days, but are capable to make up missed fasts during the short days of winter should do so whenever they can and they aren`t obliged to pay a ransom.

What is the ruling on undergoing  dialysis during the day time of Ramadan ?                                     

Dialysis breaks fast since the fluid used in this procedure is nutritious  as indicated by specialists of medicine, and it leads to the entering of substances into the coelom. Therefore, one who undergoes such a procedure should abstain from all matters that break fast for the rest of that day if he could, and make up for it after Ramadan.

Does having an endoscopic operation during the day of Ramadan invalidate fast ?

 Undergoing an endoscopic operation-whether through the mouth, the nose, or the front and back outlets- invalidates fast, and one who undergoes such a procedure should abstain from matters that invalidate fast for the rest of that day out of respect, and should make up for it after Ramadan.

Sixth: Dermatology

What is the ruling on applying cream or oil on face, hands..etc. during the day time of Ramadan ?

Applying a  moisturizing cream or oil during the day time of Ramadan doesn`t invalidate fast because it doesn`t get into the coelom, and whatever amount reaches under the skin does so from a closed outlet which is the pores.

What is the ruling on using patches in order not to feel hungry, or feel like smoking during the day time of Ramadan?

Fasting is a great act of worship and a major pillar of Islam. If the Muslim Ummah( nation) realizes the reward of  this month, it will hope that the whole year is a Ramadan. Actually, having Sahoor( pre-dawn meal ), and breaking fast according to the Prophet`s Sunnah eases  a fasting person`s hardship during the day time of Ramadan. Therefore, there is no need for using such patches although they don`t render fasting void as they aren`t nourishing and don`t access the coelom from an open outlet. It is preferable not to use such patches because they are harmful and contradict the wisdom behind fasting.

Seventh: Gynecology

Does undergoing the following procedures during the day time of Ramadan invalidate fast: an internal examination of the uterus, injection of seminal fluid, suction or restoration of ova, placing a means of birth control, hysteroscopy, and using vaginal suppository?

Every procedure that involves driving an object into a woman`s uterus during the day time of Ramadan invalidates her fast for that day; therefore, a woman should avoid such treatment during the day time of Ramadan, save when necessary. A woman who has already undergone such a treatment should continue her fast for the rest of that day out of respect for this holy month and make up for it after Ramadan.

Question: Is it permissible to delay menses  by using medication  in order to fast Ramadan?

If a woman takes such a medication and sees no menstruation blood, then her fast is valid. However, we recommend that she doesn’t do so, save when necessary. Also, she is prohibited from taking this medication if she, or her doctor know that there is a slight chance   of risk on her health.

Question: Is it permissible for the pregnant and the suckling to break their fast during the day time of Ramadan?

Answer:  If they are capable of fasting, then they should fast, but if they suffered harm or unusual hardship, then they should break their fast and make up for it, only. However, if they broke fast in fear for the fetus and the baby, then they are obliged to make up for it, and pay the ransom which is feeding a needy person(600 grams of wheat or rice) against each of the missed fasts.

Eighth: The Urinary Tract

Does using suppositories, injections, and hemorrhoids ointments invalidate fast ?

Anus injections, or suppositories administered  through any of  the open outlets invalidate fast for Ibn Abbass{May Allah be pleased with them} said: “ Fast is broken by what gets into one`s body, not what gets out”{Narrated by Al-Baihaqi in ”Ass`sunan Al-kobrah.”However, such medications should be used either before dawn, or after Magrib time(breaking fast). But, if one needed to use them during the day time of  Ramadan ,then he may do so, and abstain from matters that invalidate fast for the rest of that day.

Ninth: E.R Clinic

What is the ruling on drawing a blood sample or donating blood during the day time of Ramadan? 

Drawing blood or donating it doesn`t annul fast because it has the same rule of Hijama(cupping) which the Prophet(PBUH) underwent while fasting. Blood donation is about drawing blood out of one`s body not the other way around, so what gets out doesn`t render fast invalid for Ibn Abbass (May Allah be pleased with them) said: “Fast gets broken by what gets into one`s body not what gets out of it.” However, it is discouraged to donate blood during fast except for a sound reason since it may undermine the fasting person`s endurance and cause him to break fast.

What is the ruling on intramuscular injections, and do they render fasting invalid ?

Intravenous and intramuscular injections taken for the purpose of treatment  do not invalidate fasting because they don`t enter the coelom from an open outlet. However, venous injections taken for the purpose of nutrition render fasting invalid because they are  like eating and drinking.

What is the ruling on insulin injections taken during fast ?

 Insulin injections don`t annul fast because they are subcutaneous and don`t reach the coelom.

Does sustaining  cuts and bleeding during the day time of Ramadan annul fast ?

If these cuts lead to the entering of blood, or an object into the coelom, then the fast is void. As for cuts and external bleeding, they don`t annul fast since  nothing enters the coelom.

What is the ruling on undergoing external surgeries and Hijama(cupping) during the day time of Ramadan?

Undergoing such procedures during the day time of Ramadan without anything entering into the coelom doesn`t invalidate fast, and the same ruling applies to Hijama. However, it is discouraged to undergo  them during the day time of Ramadan because they could weaken the body and lead the person to break his/her fast; therefore, it is preferable to undergo them at night, or after the month of Ramadan.

Does vomiting  invalidate fasting ?

Intentional vomiting invalidates fasting; whereas, unintentional vomiting doesn`t,  provided that none of the vomit goes back to the coelom, but if it did, then the fasting of that day is considered invalid, for the Prophet(PBUH) said: “"If a fasting person is forced to vomit, he does not have to make up for that day, but if he vomits intentionally, then he has to make up for it." [At-Tirmithi].

What`s the effect of falling unconscious and being completely anesthetized on the validity of one`s fast during the day time of Ramadan ?

One who falls unconscious or undergoes anesthetization during  the day time of Ramadan after having made the intention to fast from the night before and having woken up-even one moment- before sunset, his fasting is valid. Nonetheless, if the state of unconsciousness  or anesthetization continued from dawn time until sunset, then his fasting isn`t accounted for, and he should make up for it after Ramadan.

Note: The above rulings are adopted by the Jordanian General Iftaa` Department 

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Summarized Fatawaa

Is it permissible to slaughter a sheep on Eid al-Adha with the intention of charity (sadaqah) on behalf of a sick person, and with the intention of udhiyah (sacrificial animal) at the same time?

Praise be to Allah, and peace and blessings be upon our Master, the Messenger of Allah.
 
The udhiyah (sacrificial animal) is an act of worship intended for its own sake; therefore, it must be slaughtered with the intention (niyyah) of udhiyah.
 
Whoever intends to draw closer to Allah through this act of obedience with the intention of udhiyah, and also intends to gift the reward to another person, there is no Islamic objection to that. And Allah Almighty knows best.

What is the ruling on offering a sheep as a sacrifice (Udhiyah) if its fat-tail is sound, except that when it was young, the tip of its fat-tail was cut so that it would grow larger? And what is the ruling in case of doubt regarding the amount that was cut?

 
In the Name of Allah, and may peace and blessings be upon our Master, the Messenger of Allah.
 
Cutting a minor, insignificant portion from the tip of an animal's fat-tail (al-alyah) to encourage it to grow larger is not considered a defect, and it does not prevent the animal from being valid for sacrifice (Udhiyah).
 
It is stated in Tuhfat al-Muhtaj (Vol.9/P.352): "There is some scholarly deliberation regarding the common practice of cutting the tip of the fat-tail so that it grows larger. It could potentially be likened to a partial cut of the ear—supported by the jurists' general rule: 'even if it is a small amount.' On the other hand, if it is an exceptionally minor cut, it might have no effect on validity. This is explicitly clarified by the juristic exception to the general rule, which states that cutting a tiny piece from a large limb causes no harm. This latter view is more well-founded.
 
Furthermore, I found that some scholars investigated this matter and concluded: 'It should not affect validity if a custom-sanctioned portion of its fat-tail is removed during its youth to make it grow larger and look better, just as castrating a male animal causes no harm.' However, applying this unconditionally contradicts the established texts of the jurists, as understood from what I have laid out; thus, the restriction I specified is what must be relied upon."
 
Similarly, it is mentioned in Nihayat al-Muhtaj (8/135): "If a small piece is cut from the fat-tail to help it grow larger, the most well-founded view is that the sacrifice remains valid, as was given in a formal legal verdict (Fatwa) by my father [Shihab al-Din al-Ramli], may Allah be pleased with him. This is proven by the jurists' maxim: 'The loss of a tiny piece from a large limb causes no harm.'"
 
In cases where there is doubt as to whether the portion cut was large or small, the animal is still deemed valid for sacrifice. It is noted in Hashiyat al-Shubramallisi ‘ala Nihayat al-Muhtaj (Vol.8/P.135):
 
"This matter requires careful consideration, but the closer and more correct view is that it is valid. This is because soundness is the default state for the animal from which the piece was cut, and it aligns with what usually occurs—namely, that the part removed to help the fat-tail grow larger is naturally very small." And Allah the Almighty Knows Best.

Should missed Sunnah prayer be made up?

Making up missed voluntary acts of worship is from Sunnah.

What should a person, who doubts the validity of his Wudu, or over performs it, do?

One who doubts the validity of his/her Wudu while performing it should redo it until he/she is certain of having attained purity. But, if doubt was after having performed Wudu, then he/she should not pay attention to that as doubt after the end of an act of worship does not count. This is of course in case doubt was within the reasonable limits since once it goes beyond that, it becomes a whispering of the Shaytaan (devil) which he/she should ignore as the Wudu is valid.

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