The Yes & No of Medical Procedures during Ramadhan
(Malaysian Medical Gazette) – The principle of fasting is that the person who is fasting is to fast in a moderate manner, neither putting himself in a severe disadvantage of health by doing anything that causes weakening of the body, nor is he allowed to ‘cheat’ via additional energy from external forces. A simple guide to fasting is succinctly described in a verse from the Holy Qur’an and further completed by various hadiths by the Prophet (saw).
It has been made permissible for you the night preceding fasting to go to your wives [for sexual relations]. They are clothing for you and you are clothing for them. Allah knows that you used to deceive yourselves, so He accepted your repentance and forgave you. So now, have relations with them and seek that which Allah has decreed for you. And eat and drink until the white thread of dawn becomes distinct to you from the black thread [of night]. Then complete the fast until the sunset. And do not have relations with them as long as you are staying for worship in the mosques. These are the limits [set by] Allah , so do not approach them. Thus does Allah make clear His ordinances to the people that they may become righteous. (Al-Baqarah 2:187)
The verse above mentions briefly the 3 acts that nullifies fasting, which are:
Several authentic hadiths from the Prophet further adds to the above the following:
Anything regarded as eating or drinking eg. Smoking, blood transfusions, IV infusions, dialysis
Letting blood by means of cupping and the like eg. Blood donation
Menstruation and nifaas (post partum bleeding)
Based on the above as well as further discussions between Fiqh scholars and physicians, several common medical procedures had been highlighted and the following was summarized by The Council of the Islamic Fiqh Academy regarding surgical and several gynecological methods of examination and diagnosis.
1. Anything introduced into the uterus, be it digital examination (examination using fingers), per speculum, suppositories, bath water, intrauterine devices (IUDs) for whatever reason, ureteroscope (a camera at the end of a tube to visualize the uterus) or intra vaginal auscultation does not nullify fasting.
2. Anything introduced through your anus that does not reach the stomach and/or the procedure does not involve the absorption of substance does not nullify the fast. Examples include: per rectal examination, enemas, and rectal scope.
3. Anything introduced into the urinary tract of a man or a woman: probe, ureteroscope or radio-opaque substances (can be visible on X-Ray), following the same principal as the gynecological examination in 1 also does not nullify the fast
4: Anything introduced through the mouth however, further down the digestive tract from the areas involving dental procedures DOES NULLIFY fasting. This is because, anything introduced to the throat might trigger the swallowing reflex and further down; for example gastroscope or similar will cause unintentional absorbtion of procedure related substances.
However, prior to each diagnostic study it is advised that the physician should counsel for postponement if there is no urgency indicated.
Dr. Siti Nurhayati Adznan is a private general practitioner in Melaka.
The Council of The Islamic Fiqh Academy
(THE MALAYSIAN MEDICAL GAZETTE)