Communal Ramadan prayers at Mecca's Grand Mosque.
The Qur'an on Ramadan (click blue hyperlink at bottom of the e-mail to view video)
By Robert Mitchum
Chicago Tribune [August 31, 2008]
For Muslims such as Nadia Aslam, the tradition of fasting from dawn to dusk during the lunar month of Ramadan is a treasured experience of sacrifice and spiritual resolve.
"There's a different feeling in Ramadan. I just feel closer to God," said Aslam, 26, who lives in Glendale Heights.
But when Aslam entered Ramadan seven months pregnant in 2006, she faced the difficult decision of whether it would be in the best interests of her and her unborn child to observe the tradition of going without food, drink or medication during the daylight hours of 29 or 30 days.
For the first three days of Ramadan, Aslam said she followed the example of older relatives and tried to fast, but she found that it made her feel lightheaded and ill. When she consulted her obstetrician, her doctor recommended that she end the fast, news that Aslam initially found difficult to take despite the Quran, Islam's holy book, giving pregnant women an exemption from fasting.
"It was disappointing because fasting is one of the main things we are supposed to do in Ramadan," Aslam said. "But in the end, I felt she was right . . . I knew that in the end it was best for the baby."
But in an example of scientific innovation helping to facilitate traditional practices, doctors more often are using advances in medical technology to help Muslims struggling with chronic illnesses to fast during Ramadan, which starts on Monday, without consequences. And while consensus is sometimes difficult to find, some Islamic scholars have reassessed whether certain medical treatments are a violation of the rules for fasting.
"It is a balance," said Dr. Mohammed Zaher Sahloul, a pulmonary, critical care and sleep specialist in Oak Lawn. "We want to give them the chance to do it because of the blessing and reward they expect to get. But at the same time, we don't want them to have complications or problems related to health issues."
The Quran scripture that describes the traditional Ramadan fast allows some exemptions, reflecting the religion's overarching belief that Muslims should not harm their bodies, even for spiritual practices. Those unable to fast—including travelers, children and breast-feeding and menstruating women—are expected to make up the fasting later or make a donation to help feed the impoverished.
"In no way should you be hurting your body during the process of fasting," said Dr. Hafizur Rehman, a pediatrician and president of the Islamic Medical Association of North America. "Fasting is for you to come closer to God, to feel godliness and to feel the pain and hunger of other people in that process. But it has to be reasonable. God is not looking to punish you in any way. He is looking to bring you closer to him."
For Muslims suffering from severe chronic illnesses that would be exacerbated by fasting, the decision not to fast is usually clear, Rehman said. But Muslims with diseases such as diabetes or asthma that must be controlled with regular medication face a tougher choice, and often consult both doctors and religious scholars about whether they should observe the annual fast.
Dr. Hussain Sattar, a pathologist at the University of Chicago and part-time Islamic scholar, said he is approached by as many as 20 people each year with questions about whether it is spiritually proper for them to fast or not because of a medical condition.
"You get two extremes in that circumstance," Sattar said. "One extreme is that a person may try to get out of the fast because they really don't want to do it and use the illness as excuse. But the other extreme is a patient who so badly wants to fast, and even though ill, they will try to fast."
Doctors say they usually come across the latter case, forcing creative strategies and the adjustment of medication schedules to meet the Quran's requirement that no substance pass the throat during fasting.
Rehman, who is diabetic and said he has fasted for the last 20 Ramadans with no complications, makes sure that the diabetics he treats change the timing and dose of insulin injections and closely monitor their blood-sugar levels throughout the daylight hours.
For patients struggling with high blood pressure, heart disease or other illnesses requiring regular medication, the development of longer-acting pharmaceuticals that don't need to be taken as frequently have helped more patients fast, Sahloul said.
"Technology may make it actually easier for patients to fast in the future than it was previously," Sahloul said. "The trend now is to shift to longer-acting medicines and shift to patches instead of oral medication. It will make it much easier for patients to fast if they are taking one pill a day instead of three or four."
But exactly which treatments are allowed during the daylight hours remains a matter of debate within the Islamic community. The use of inhalers by asthmatics, for instance, was ruled to not break the fast by a meeting of Muslim experts and doctors in Morocco in 1997, Sahloul said. But Sattar said he advises people that inhalers should not be used by fasting Muslims, because it would allow particles to enter the throat.
Regardless of debates over suitable treatments, Dr. Memoona Hasnain, director of family medicine research at the University of Illinois at Chicago, said that open communication between patient and doctor is crucial to prevent Muslims from putting themselves at risk by fasting. Hasnain—who, like Nadia Aslam, once tried to fast while pregnant but stopped after advice from her doctor—said religious respect is especially critical in cases where a Muslim may be asking advice from a non-Muslim physician.
"There needs to be more work done to develop that trust between western clinicians and Muslim patients," Hasnain said. "Doctors need to be sympathetic to patients, willing to listen and accommodate their beliefs as much as possible. But the most important thing is the well-being of the patient."