Medical Treatment or Interventions and Impact on Fasting Validity
Khalid Jazieh, MD.
Hematology Oncology Fellow, Mayo Clinic. Rochester Minnesota
Board Certified in Internal Medicine (Cleveland Clinic)
This chapter was reviewed by Sheikh Ihab Mohamed Alsaghier, Imam of Ihsan Islamic Center, Milford, OH.
Introduction:
With the advancements of modern medicine, there are now numerous situations in which patients may need a variety of medical interventions ranging from pills to injections to invasive procedures. Scholars study these interventions and do their best to determine which of them may invalidate, or break, the fast. While there is usually a significant overlap in fatwahs, there are differences of opinions between scholars / fiqh councils on a number of these issues.
Things vary based on the person involved, their medical conditions, and treatments they need. We will not be able to cover all situations, but most of the health risks with fasting come from 3 things:
Lack of sufficient hydration
Changes in dietary habits (e.g. carbohydrates in those with diabetes)
Missing medications
As a general rule, if a treatment or intervention is not urgently needed then it is better to schedule it outside of fasting hours in Ramadan. If it is medically urgent to receive the treatment then it should be done, and even if it breaks the fast the patient can make up that fast later. It is important to maintain adequate hydration and nutrition between Iftar and Suhoor time. Patients are advised to check with their physicians prior to fasting.
In this chapter we will be referencing fatwahs by reputable English sources, primarily the Assembly of Muslim Jurists of America (AMJA) and the fatwahs of Sheikh Muhammad Saalih Al-Munajjid available on his website. Please note there can be differences of opinions on some of these matters between scholars, especially those of different madhahib (schools of Fiqh). We recommend asking your local, reputable scholars for advice and guidance in personal situations.
Oral Medications:
There is agreement between the scholars that swallowing pills or other forms of oral medications (including liquids) during fasting hours invalidates the fasting. As such, it is recommended to take oral medications outside of fasting hours, or to make up those days of fasting if possible 1,2. However, some scholars make an exception for medications that are kept under the tongue (sublingual) rather than swallowed with precaution not to swallow any of the medicine. Inhaled medications (e.g. asthma inhalers) are also acceptable during fasting and do not violate the fast (see Table 1 for more information) 1,3,4.
Injections (intravenous/intramuscular/subcutaneous):
Generally the scholars divide injections into two types 5–7:
Nutritional: Getting IV fluids or nutrition, and this would invalidate the fast. Along these lines, most modern scholars consider receiving a blood transfusion or undergoing dialysis to be similar to getting IV nutrition.
Medicinal: Getting an injection for treatment of a condition, and a number of scholars have issued fatwahs that these do not invalidate the fast.
Drops:
Generally, scholars have issued fatwahs that eye drops, ear drops, and nose drops do not invalidate the fast as long as the medication does not reach the throat 1,8.
Enemas/Suppositories/Catheters/Endoscopy:
Medicines administered via enemas or suppositories (rectal/vaginal), as well as urinary catheters do not break one's fast. Procedures like endoscopies do not violate the fast as long as solutions are not administered into the gut 1.
Creams/Emollients/Patches:
Medications applied topically do not violate the fast 9.
Smoking:
Smoking violates the fast 10,11.
For a summary of a list of interventions that may or may not break the fast, please reference Table
Please note that there are differences in certain rulings in Mathaheb. Please check with your sheikh to clarify specific situations for you.
It is prudent whenever medically allowed and possible to take the treatment or the procedure outside fasting hours in doubtful situation, if it does not pose harm to your health.
References:
1. Al-Munajjid, S. M. S. What Breaks Your Fast - Islam Question & Answer. https://islamqa.info/en/answers/38023/what-breaks-your-fast#anything-that-is-regarded-as-coming-under-the-same-heading-as-eating-and-drinking.
2. Al-Qudah, M. K. V. URGENT PLEASE MEDICINES AFTER STARTING FAST | AMJA Online. https://www.amjaonline.org/fatwa/en/82129/v-urgent-please-medicines-after-starting-fast.
3. Al-Haj, H. Using Asthma Inhaler During Ramdan | AMJA Online. https://www.amjaonline.org/fatwa/en/87147/using-asthma-inhaler-during-ramdan.
4. Al-Munajjid, S. M. S. Does Inhaler Break Your Fast? - Islam Question & Answer. https://islamqa.info/en/answers/78459/does-inhaler-break-your-fast.
5. Al-Munajjid, S. M. S. Ruling on injections and intravenous fluids for one who is fasting, and the impact of the intention (niyyah) on invalidating the fast - Islam Question & Answer. https://islamqa.info/en/answers/250660/ruling-on-injections-and-intravenous-fluids-for-one-who-is-fasting-and-the-impact-of-the-intention-niyyah-on-invalidating-the-fast.
6. Al-Sawy, S. Muscular Injections | AMJA Online. https://www.amjaonline.org/fatwa/en/22109/muscular-injections.
7. Al-Sawy, S. Injections While Fasting | AMJA Online. https://www.amjaonline.org/fatwa/en/3719/injections-while-fasting.
8. Al-Qudah, M. K. Eye Drops And Fasting | AMJA Online. https://www.amjaonline.org/fatwa/en/77001/eye-drops-and-fasting.
9. Al-Munajjid, S. M. S. Ruling on skin patches in Ramadaan - Islam Question & Answer. https://islamqa.info/en/answers/8226/ruling-on-skin-patches-in-ramadaan.
10. Al-Haj, H. Smoking & Fasting | AMJA Online. https://www.amjaonline.org/fatwa/en/87146/smoking-fasting.
11. Al-Munajjid, S. M. S. Is Smoking in Ramadan Haram? - Islam Question & Answer. https://islamqa.info/en/answers/37765/is-smoking-in-ramadan-haram.
12. Al-Munajjid, S. M. S. Fasting of one who loses consciousness - Islam Question & Answer. https://islamqa.info/en/answers/37684/fasting-of-one-who-loses-consciousness.
13. Al-Munajjid, S. M. S. Does Vomiting Break Your Fast? - Islam Question & Answer. https://islamqa.info/en/answers/38205/does-vomiting-break-your-fast.
14. Al-Munajjid, S. M. S. Does Your Fast Break If You Bleed? - Islam Question & Answer. https://islamqa.info/en/answers/37918/does-your-fast-break-if-you-bleed.
15. Al-Munajjid, S. M. S. Is It Permissible to Take Medicine While Fasting? - Islam Question & Answer. https://islamqa.info/en/answers/65871/is-it-permissible-to-take-medicine-while-fasting.
