Currently in the fasting month of Ramadhan, there are few matters in medicine differ.
The main headache used to be adjusting the insulin administration for diabetic mothers who is fasting.
The second obstacle is to defer the essential examination of the genitalia to detect potentially dangerous disease. Many or should I say, most of my patients would rather postpone it as they seriously believe it would break their fasting practice as would sexual intercourse.
Usually, everyone in the department (from various religions and faith) are happy to accept that they are happy deferring the essential examination, unless the patients are in dire state of collapse.
Somehow I was in the dark and continued to accept to believe that such examination is to be avoided in order for the patient to continue their holy practice of fasting.
Till this year, I stumbled upon an outdated Islamic review which was then further echoed in Facebook. I realized those vital examination does not break fasting.
I guess part and parcel in this profession is to impart the correct information to the patients..
Unfortunately, for the past 5 months of Ramadhan, I had given the less accurate information and many patients had chosen to defer the essential examination and live with a certain degree of anxiety till after Raya before complete assessment can be made.
Learning is indeed a lifelong process.
P.S. Perhaps local medical schools should add in a class on practicing medicine with consideration on different faith and religion in Malaysia.
http://abuzar-azuan.blogspot.com/2009/09/perkara-yang-tidak-membatalkan-puasa.html
Keputusan Seminar Feqh Perubatan ke 9, yang diadakan di Casablanca, Maghribi pada 8-11 Safar 1418, bersamaan 14-17 Jun 1997 :
(Anjuran Institut Kajian Sains dan Perubatan Sultan Hassan II dengan kerjasama Akademi Fiqh Islam serta WHO -World Health Organization)
Ahli majlis/peserta seminar tersebut telah sepakat bersetuju bahawa perkara-perkara berikut TIDAK MEMBATALKAN PUASA.
1. Ubat titis mata, titis telinga dan basuh telinga
2. Ubat tablet bawah lidah yang digunakan oleh pesakit Angina (Jantung). [contoh: Sublingual Gliceryl Trinitrate]
3. Memasukkan ubat melalui faraj, memasukkan alat perubatan, membasuh, memasukkan spekulum dan jari doktor atau bidan semasa pemeriksaan vagina (sebelum bersalin) [contoh: vaginal examination, speculum examination, cervagem]
4. Memasukkan teropong ke salur kencing lelaki atau perempuan untuk penyediaan x-ray. [contoh: cystoscopy]
5. Menampal, mencabut, mengorek dan mencuci gigi atau menggunakan alatan dan berus gigi, dengan syarat TIADA apa-apa bahan yang memasuki perut dari prosedur tersebut. [contoh: Dental procedure]
6. Suntikan melalui kulit, otot, sendi atau pembuluh darah, KECUALI memberi makanan melalui pembuluh darah. [makanan i.e Total Parenteral Nutrition regime. Not sure about IV drips, vitamins, glucose, but if needed for therapeutic purposes, then it is Harus]
7. Penderma atau menerima pemindahan darah
8. Oksigen dan gas bius
9. Semua jenis bahan yang boleh menyerap ke dalam badan melalui kulit seperti krim, jelly atau plaster berubat
10. Mengambil sampel darah untuk ujian makmal
11. Sesalur dan bahan perantara untuk arteriography (pemeriksaan x-ray khas jantung) atau organ lain. [contoh: Angiography, contrast for imaging]
12. Teropong dalam rongga perut (endoskopi) untuk mencari punca penyakit.
13. Membasuh mulut, berkumur atau semburan mulut, dengan syarat tiada bahan masuk ke dalam perut. [contoh: Ear Nose Throat examination]
14. Teropong ke dalam salur peranakan atau memasukkan alat kedalamnya, (contoh: Intra Uterine Contraceptive Device)
15. Mengambil tisu (biopsi) hati atau organ lain.
Sementara iu majoriti peserta (terdapat minoriti yang tidak bersetuju ) menambah perkara berikut TIDAK MEMBATALKAN PUASA [No 16 sehingga 20]
16. Ubat titis hidung, semburan hidung dan ubat sedut
- Bagi penyakit asma atau lelah, amalan penggunaan inhaler tidak membatalkan puasanya kerana yang disedut itu ialah gas dan untuk tujuan perubatan. Ini adalah fatwa kebanyakan ulama masakini seperti Sheikh Ben Baz dan merupakan pendapat majoriti ulama yang bersidang di Seminar Feqh Perubatan ke 9.
- Keharusan penggunaan inhaler bagi pesakit asma juga harus berdasarkan fatwa umum dalam masalah ini oleh Syeikhul Islam Ibn Taymiyah. Keharusan ini meliputi teknik perubatan yang tidak menggunakan makanan atau minuman. Jika dari jenis debu maka diharuskan.
- Imam Ibn Hazm al-Andalusi (Kitab al-Muhalla) juga berpendapat tidak batal puasa dalam urusan perubatan termasuk suntikan atau menghirup serbuk.
17. Suntikan ke dalam dubur, teropong dan pemeriksaan digital ke dalam dubur.
18. Pembedahan yang melibatkan bius sepenuhnya jika pesakit mengambil keputusan untuk berpuasa
20. Penggunaan teropong perut, dengan syarat tidak memasukkan apa-apa bahan cecair atau bahan seumpamanya ke dalam perut [tidak pasti: saline for washout]
http://lansingislam.com/ramadan3.htm
Which medications/actions are permitted whilst fasting?
The following is a summary of shar’i research presented to the Islamic Fiqh Council during its regular meetings:
The following things do not have any effect on the fast:
- Eye drops, eardrops, ear syringing, nose drops and nasal sprays – so long as one avoids swallowing any material that may reach the throat.
- Tablets or lozenges that are placed beneath the tongue for the treatment of angina pectoris etc., so long as one avoids swallowing any material that reaches the throat.
- Vaginal pessaries, douching, use of a speculum, or internal digital examination.
- Introduction of a scope or coil (IUD), etc., into the uterus.
- Introduction of a scope or catheter into the urethra (male of female), or injection of dyes for diagnostic imaging, or of medication, or cleaning of the bladder.
- Drilling of teeth (prior to filling), extraction or polishing of teeth, using a miswaak or toothbrush, so long as one avoids swallowing any material that reaches the throat.
- Rinsing, gargling or applying topical treatment in the mouth, so long as one avoids swallowing any material that reaches the throat.
- Injections, whether subcutaneous, intra-muscular or intra-venous – with the exception of those used for purposes of nutrition.
- Oxygen.
- Anesthetics, so long as they do not supply nutrition to the patient.
- Medicines absorbed through the skin, such as creams, lotions and patches used to administer medication through the skin.
- Introduction of a catheter into the veins in order to examine or treat the vessels of the heart or other organs.
- Laparoscopy for the purpose of diagnosis or surgical treatment of the abdominal organs.
- Biopsies of the liver and other organs, so long as this is not accompanied by the administration of nutrients.
- Gastroscopy, so long as this is not accompanied by the administration of nutrients.
- Introduction of medicine or instruments into the brain or spinal cord.
- Involuntary vomiting (as opposed to self-induced vomiting).
It is however preferable to postpone the above-described treatments and procedures until after he has broken his fast, if it is safe to do so.
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