Home 
Contact 
Profile 
Videos 
5.0 IBADAT OBLIGATIONS FOR THE SICK
5.1 Taharat For The Sick, Taharat Al Mariidh
Tayammum is carried out when it is difficult to use water. In hospital practice doctors come across many questions concerning patient hygiene, nadhafat al mariidh. Blood is the most often encountered intravascular fluid. Fresh blood is not najs when in the body Blood of epistaxis is not najasat[1] but must be washed away immediately. Freshly spilled blood (venous or arterial) is not najasat but must be cleaned away with water[2] [3] and does not require repeating wudhu.. At the time of the prophet the therapeutic procedure of cupping, hijaamah, was common and the blood was not treated as najs[4]. Pleural, peritoneal, pericardial, and synovial fluids are not najs and must be washed away if they are outside their respective cavities. Respiratory secretions are not najasat but must be washed away. Upper GIT vomitus is not najs and does not nullify wudhu. This is because contents of the upper GIT are mostly recently ingested food. The lower GIT vomitus especially the lower intestine has fecal excretory material that is najs. Vomitus that is severe may contain intestinal contents and should always be considered najs. The vomitus of a baby is treated like its urine. Diarrhea is najs and nullifies wudhu. Esophageal, gastric, and naso-gastric tubes are inserted for diagnostic or therapeutic purposes. The fluids involved are not najs but must be washed away to prevent their becoming nidi of infection. A tracheostomy tube may be inserted in cases of respiratory distress and respiratory secretions may accumulate in it. These secretions are not najs.
Stoma have to be cleaned and salat is done with them discharging.
5.2 Haidh
Artificial menopause is necessary, dharuurat, if there is serious disease like cancer. Delay of menopause is offensive if done for purposes of appearing young to the general society. The Law in general is against any deceptions regarding a person's age. Estrogen replacement therapy (ERT) can alleviate virtually all menopausal symptoms. ERT has serious side effects that have to be considered under the two principles of benefit and harm. The menstrual flow may be prolonged in association with menorrhaghia and without it. The Law considers 15 days the maximum duration of the menstrual flow. Salat and fasting are suspended during this time. Salat and other acts of ibadat are resumed if the flow continues beyond 15 days since prolonged bleeding, istihaadhat, is not considered menstruation[5]. DUB does not stop the woman from salat or saum and is treated as urinary incontinence. The woman washes her vagina and perineum, pads herself, makes wudhu and prays immediately to try to avoid being caught by more bleeding. Sexual relations are allowed in DUB unless there is a medical contra-indication[6]. The use of hormones to regulate the menstrual period in order to be able to complete the rituals of pilgrimage is widely used. The same cannot be done for Ramadhan.
5.1 Salat Of The Sick, Salat Al Maridh
The patient may have the following physical handicaps: inability to face the qiblat, inability to stand, inability to sit, inability to read, inability to bow, and inability to prostrate. The following are solution alternatives: make-up salat, qadha al salat; resting for moments in a sitting position to regain energy for the next movement; praying in a sitting position; praying while sitting down and cross-legged; praying while lying down on one side of the body; resting on a staff in salat; Praying by gesturing with one part of the body e.g. finger; and finally praying in the mind with no motions. The sick stop qiyam al layl and try to fulfill the 5 prescribed prayers. Salat can be interrupted for an urgent need that could be medical or otherwise. Women are excused from salat during the period of menstruation because of the associated physiological stress.
5.3 Saum For The Patient, Saum Al Mariidh
Measures to prevent physiological harm in saum: The prophet (PBUH) taught measures to ensure that saum does not cause physiologic damage. Saum continuously from day to day, wisaal, was forbidden[7]. Early iftaar was recommended[8]. Delaying suhuur was recommended[9].
Medical guidelines on diet in saum. The aim should be maintaining normal body weight or actually reducing it if overweight. Over-eating at iftaar and suhuur should be avoided. It will cause weight gain and indigestion. The diet should contain sufficient fiber to prevent constipation. Fiber and slowly digested foods with a long stomach transit times are preferred because they delay the feeling of hunger. Enough water should be taken at night both for preventing dehydration and preventing constipation. Adequate fluid and salt intake prevents lethargy in the afternoon caused by low blood pressure.
Inadequate sleep is a cause of headaches. Intake of adequate calcium, magnesium, and potassium will prevent muscle cramps. Hot places should be avoided because they aggravate the dehydration. Cooling the body such as tepid sponging, tabarrud, is allowed[10] during saum.
Old age: Old age is considered an excuse from saum[11] because of physiological fragility and delicate nutritional requirements.
Diabetes mellitus: Diabetes has special consideration in saum because of its direct relationship with food intake. Insulin-dependent diabetics have to reduce their insulin dose because of reduced food intake during the day. In some cases this is not possible and they have to be exempted from saum altogether especially if their diabetic control is brittle. Insulin-dependent diabetics should be monitored very carefully because hypoglycemia may arise due to insulin injections with inadequate dietary intake. Non-insulin diabetics can undertake saum under medical supervision. This will generally require changing times of medication, close monitoring of blood sugar levels, and being alert to any hyperglycemic or hypoglycemic crises. Pregnant diabetics are exempted from fasting because diabetic control is more difficult in pregnant women making fasting doubly hazardous for both the mother and the fetus.
Other conditions of Illness: The sick are allowed to break saum[12] if trusted physicians fear that saum will be deleterious to good health. The missed saum is made up later[13]. If the illness is chronic, maradh muzmin, then there will be no opportunity for making up. The saum of a sick person is valid but is makruh. The heirs can perform make-up fasting, qadha al saum, for days missed by a deceased disabled by disease in terminal illness[14]. Peptic ulcers are aggravated by raised acid levels and could be a reason for exemption from saum. Low fluid intake could encourage growth of kidney stones and joint problems due to deposition of excess solutes.
Saum in difficult weather: Saum in conditions of extreme heat leads to dehydration. Care should be taken to take enough fluids at suhuur and not to expose oneself to extreme environmental temperatures. In very cold areas, the metabolic rate is raised to be able to generate sufficient heat for maintaining body temperature. In such conditions extra care should be taken to consume enough food and to cover oneself properly to minimize heat loss. Regions of the world near the two poles may have extremely long days in summer and very short ones in winter. It is recommended that the times of suhuur and iftaar of the nearest temperate region should be followed rather than following local sun-rise and sunset.
Saum in pregnancy, menstruation, and the post partum period: The pregnant woman, al hublah, is allowed to break saum[15] if saum is a health risk. The breast-feeding woman or nursing woman, al murdhi'[16], is allowed to break saum if there is health risk. The exemption from fasting is obligatory for the menstruating woman, al haidh[17], and for a woman in the post partum period, nifaas[18]. Any fasting undertaken in haidh and nifaas is invalid.
Concept of jawf: Any potentially nutritious substance that enters and stays the inside cavity of the body, al jawf, nullifies saum. The term jawf has to be reinterpreted in view of modern anatomical and physiological knowledge. In my understanding jawf means the alimentary canal from the mouth to the anus.
Oral intake: Deliberate eating and drinking and eating nullify saum. Smelling food or any other pleasant odor does not nullify saum Use of snuff or tobacco in the nose nullifies saum. Deliberate smelling of tobacco or any other type of smoking material nullifies saum. If the smelling is non intentional it does not nullify the saum. Madhmadhat and istinshaaq in wudhu are permitted during saum[19]It is however offensive to exaggerate them[20]. The decision of what is normal and what is excessive requires more discussion. More discussion is needed on swallowing saliva and swallowing phlegm during saum. The mouth can be rinsed with pure water without nullifying saum. Care must be taken to avoid swallowing Siwaak is permitted all through the day of saum[21]. Use of a tooth brush with toothpaste is allowed if care is taken to rinse out the mouth fully such that none of the toothpaste remains in the mouth. The ear-drum was traditionally considered a nullifier of saum but unless the eardrum is perforated there is no direct connection between the ear and the jawf. Eye drops enter the nostrils and may eventually reach the pharynx probably reaching the jawf. Kohl applied to the eye does not nullify saum if its smell is not felt in the mouth.
Medical examination and investigations: Taking blood, urine, and stool samples for investigation does not nullify saum. Diagnostic enemas and barium meal examinations nullify saum. Esophagoscopes, gastroscopes, and sigmoidoscopes that have lubricants or other substances that will remain in the jawf nullify saum. Digital rectal examination involves inserting substances into the jawf and may nullify saum. Vaginal examination may nullify saum but the reasoning involved is more complicated. Examination of the external auditory canal, endoscopy and catheterization of the urethra and the urinary bladder should in normal circumstances not nullify saum because they do not involve entry into the jawf. Imaging that does not involve using contrast media in the jawf does not nullify saum. IVP uses contract media injected in the blood stream and not the jawf.
Medical treatments: The general rule is that any substance that enters the body through any of its openings, manfadh, nullifies fasting. The openings are the two ends of the alimentary canal, the mouth and the anus. Drugs of whatever form taken orally, per anus, nullify fasting. The medication schedule can be modified such that drugs are taken only during the night hours. Sub-lingual medication absorbed from the oral cavity with none entering the esophagus may not nullify saum. All drugs that are applied externally on the skin do not nullify fating. Use of eye drops does not nullify fasting. Nose drops may nullify fasting because they could drop into the pharynx and be swallowed. Inhalants may nullify saum if they have droplets of water that can enter the jawf. Injections (sub-cutaneous, intra-muscular, and intra-venous) do not nullify saum because they do not involve putting substances into the jawf. However nourishing and rehydrating injections nullify the purpose of saum. Hormonal preparations should not be used to delay menstruation in order to avoid interrupting saum of Ramadhan.
5.4 Pilgrimage Of The Sick, Hajj Al Mariidh
The physically disabled can circumbulate the ka’aba riding on a vehicle or being carried by another person. The weak can leave Muzdalifat earlier to avoid the crowds. The very old and those with debilitating chronic diseases can ask another person to perform hajj on their behalf. However if the disease is curable it is better to delay hajj until the next year. In case of a fracture, hajj is stopped and is repeated the next year. If disease occurs during hajj, the sick can be carried to Arafat because al hajj Arafat and missing Arafat is missing the whole hajj. They are assisted to complete the other rites as much as is possible
NOTES
[1] (BG69 Ibn Majah and Ahmad)
[2] (MB171 Bukhari 1:228)
[3] (MB170 Bukhari 1:227)
[4] (BG74 Darqutni)
[5] (MB171 Bukhari 1:228)
[6] (KS154 Abu Daud K1 B118, Darimi K1 B85, Muwatta K2 H108)
[7] Bukhari K30 B20
[8] Bukhari K30 B45
[9] Ahmad 5:147
[10] Bukhari K30 B22
[11] Bukhari K65 S2
[12] Bukhari K65 S2 B25
[13] 2:183-185
[14] Bukhari 3:168
[15] Bukhari K65 S2 B25
[16] Bukhari K65 S2 B25
[17] Bukhari K6 B6
[18] ( )
[19] Bukhari K30 B22
[20] Tirmidhi K6 B69
[21] Abudaud 2364