Shariah Conditions for Permissibility of Fertility Procedures

Conditions for Permissibility of Fertility Procedures (like In Vitro Fertilisation and Intra Uterine Insemination)

-Three specialist doctors should have concluded that the wife can conceive only through assisted reproductive technology and it is the only source of procreation for the couple. 

-The procedure should be carried out only during the period when the Nikah of the couple is intact.  And if the marriage has been terminated due to the death of the husband or divorce, etc., then these procedures cannot be carried out.

-It should be done by a trustworthy Muslim lady doctor, and if this is not possible, then a non-Muslim reliable lady doctor can perform this process, in case it is not possible, then a trustworthy Muslim male doctor can perform it, and if it is also not possible, then a non-Muslim trusted male doctor can do it.

-For this process, doctors should get written consent from the husband and wife, and inform them about the situation and all the stages of this process. The lineages should not be mixed with the mixing of sperms. For this, only the sperm of the husband should be used and special care should be taken to ensure it.

-The sex of the foetus should not be selected by the IVF. 

-IVF should only be done for the couples who do not have any children.

-Great care should be taken to ensure that there is no possibility of error or mix-up.

 -And the procedures on the wife should be carried out in the presence of the husband. (Al Mausu'ah al Tibbiyah al Fiqhiyyah, madah hamal: 379, 380)

 [From Jadeed Tibbi Masail of Mufti Abubakar Jaber Qasmi]

How the Current Ideological Challenges Differ from the Older Forms of Misguidance

New and Old Misguidance

Taken from the Urdu book 'Jadidiyat' by Prof. Hassan Askari

(Translated by Dr. Md. Habeeb Haris)

This chapter focuses on the challenges posed by the new forms of misguidance that have emerged. 

In the history of Islam, various misleading ideas, heretical beliefs, and doubts have emerged from time to time. Our scholars say that those influenced by Western education cannot raise any objections or doubts that the scholars of the past have not already addressed. This statement is absolutely true. All the new forms that misconceptions can take, or the new ways they can appear, are essentially the same as those that scholars have already dealt with in the past. Therefore, it is quite easy for the scholars to respond to them. However, there are a few new characteristics of these new misconceptions that make it difficult for the scholars’ responses to be completely effective.

Here are some points to consider:

* The Scope of Misconceptions: In the past, misconceptions were limited in scope, both geographically and in terms of the number of people they affected. As soon as scholars clarified the misconceptions, they would disappear or their influence would be significantly reduced. However, the new misconceptions have a global reach, and they are impacting a much larger number of people than before. Muslims all over the world are being affected by these new ideas, and they are spreading rapidly.

* Previously, misconceptions arose from within the Muslim community itself, but new misconceptions have come from the West. Moreover, these Western misconceptions are backed by their financial and military power.

* In addition, these misconceptions come with scientific innovations that gratify worldly desires and amaze ordinary people. Ordinary people do not use their minds and consider any observation to be a logical argument. Therefore, when scholars respond to these objections, their impact is not very effective.

* The Western mind has been gradually deteriorating for the past six hundred years (since the fourteenth century CE) and has been losing the ability to understand truth. In six hundred years, the West has produced all the misconceptions that have attacked us all at once. Because of this, an ordinary Muslim, despite his devotion to Islam, cannot withstand this onslaught. He gets rid of one misconception only to fall into another. In the same way, even among us, the minds of ordinary people, and especially those who have received a modern education, have gradually been deteriorating over the past century and a half.

* Old misconceptions used Islamic terminology and Islamic concepts incorrectly; therefore, they were very easy to dispel. However, new misconceptions come with a new language and new terminology. Thus, even the most disregarded and discarded ideas hide behind a veil of complex and obscure terminology, and a person becomes impressed for no reason. Since our scholars are not fully aware of the nature of this new language and these new terminologies, and their long and complex history, sometimes their responses miss the mark.

These new terms are of three types:

A. Misappropriation and Distortion of Terms

In the realm of Western thought, there has been a widespread and indiscriminate use of terminology. This includes both terms that are uniquely Christian in origin and those that are common to all religions. While these terms are employed extensively, their meanings have been completely altered. This practice can be traced back to the early stages of intellectual deviation in Europe.

B. Shifting Meanings and Lack of Consistency

The meanings associated with these terms have not remained constant over time. Instead, they have undergone continuous change, often at a rapid pace. In the 20th century, the meanings of these terms have been shifting every five years or so. In the West, the situation has become even more extreme, with different authors using the same word in ten different ways within the same era. A prime example of this ambiguity is the term "nature." The word "religion" itself has been used in such a multitude of ways that it has lost all specific meaning.

C. The Fad of Coining New Terminology

 Western writers have a peculiar penchant for inventing new terminology, regardless of whether they have anything new to say. These newly coined terms typically fall into two categories:

- Onerous and Complex Terms: These terms are often cumbersome, intricate, and sometimes devoid of any clear meaning. Their primary purpose seems to be to convey a sense of erudition. The abundance of such terms in the writings of these authors makes it difficult for readers to grasp the intended meaning, leaving them confused and disengaged.

- Emotionally Charged Terms: These terms are designed to appeal directly to the emotions, often at the expense of rational thought. 

Both types of these newly created terms are meant to hinder the reader from using his own mind.

The preaching of our scholars cannot be effective unless they are aware of the structure and methods of the present Western mind. This is why it is important to learn the intellectual history and degradation of Western thought.

The Concept of Real Success - Between Materialism and Monasticism

-Dr. Md. Habeeb Haris 

The desire for success is the fuel that propels man in the world of struggle and activity. In fact, this basic desire is behind all human actions whether individual or collective. Moreover, the behavioural patterns and path of life-struggle vary according to the variations in the concept of success. 

An individual's perception of the elements that go on to make him a successful person largely determines his lifestyle and the way he would respond to the challenges at every moment of his encounter with life. The concept of success depends on various influences like culture, religion, education, the dominant ideology, social trends, media influence. 

In the previous centuries religion was a predominant factor in the determination of this concept. But in the times that we are living in today, every concept - including the all important concept of success - is fashioned basically by the prevailing materialistic worldview. 

The materialistic ideology has overwhelmed our thinking so much that there seem to be no other criteria which can influence our judgement.

Though the materialistic concept of success is nothing new to human history, the scientific hue that it has acquired to get wider acceptability makes it all the more bewitching to the eyes of the modern man. 

However this not-so-holy embrace of materialistic ideology has left man with a lopsided view of the goal of life and has changed the very direction of his life. Once his concept of success changed, everything else changed. Man's concerns became narrower. He started running only after the mirage of worldly success, looking for things ephemeral and in the bargain lost sight of

everything that stood for permanence and eternity. 

This mad race also changed the  equations of human relations which threw the whole society in to disarray. The family structure was dismantled that left man feeling such insecurity and loneliness as he has never felt before. 

The loss of permanent values has made every thing uncertain. This erroneous concept of success has eaten away the roots of human character and opened the doors to all sorts of corruption. We see today quite helplessly that the humanity is drowning in this sea of corruption. But unfortunately this sea is of man's own making. 

Every individual and society is crying for peace but peace seems to elude all. In pursuit of happiness man is adopting crazy lifestyles, hollow entertainment and bewildering behaviour. Even religion is being exploited for selfish material gains. There is a culture of madness everywhere. The darkness of doom is all set to engulf us. 

So, if the modern materialistic concept of success has left Man at the brink of annihilation, should he now turn to oriental monasticism for the true definition of success? Alas, the Eastern (Buddhist, Hindu etc.) as well as the Western (Christian) monasticism, inspite of its spiritual aura and mystic pretentions, has shown its barrenness in this regard. Can man attain success by running away from the struggle of life? Can this world be left at the mercy of criminals and debauchees; which will be the logical outcome of truly spiritual people shying away from social involvement and taking to forests and caves in search of nirvana?

Moreover, history has seen such monasticism quite often ending up in worst forms of materialism which even ordinary people find disgusting. Many monasteries have been turned into temples of lust and corruption. Perhaps it is a logical consequence of an unnatural concept of success based not on any sound foundations but merely on superstition, ignorance and conjecture. 

So, where does man go from here? What is it that can give man the true concept of success? What are those criteria which can enable man to take the right step in the right direction? And finally how can man know what he really wants from life? This crisis is basically due to the innumerable cobwebs covering certain elementary concepts regarding man and life. 

To attain the true concept of success, man has to first understand  his true nature, his position in the universe and the purpose of his creation, because success is measured by the extent of the achievement of one's purpose. He has to realize that his presence on this planet is not just a matter of chance but rather it is the result of a very wise plan of the Creator of this universe. This fact itself makes it clear that his life and existence cannot be a purposeless wandering but has a definite aim behind it. 

This is in total contrast to the atheistic theory of "existence by chance" which at the very outset degrades man into a purposeless entity and robs human life of all meaning and direction and makes it a rudderless ship caught in a whirlpool of circumstances. 

Moreover, the truth is that man is not just one of the creatures but he is indeed God's representative in this world and he has to act as such. Neither should man rebel against his Master nor should he degrade himself by bowing before other creatures. 

This moderate approach towards his own position empowers and puts man on a firm track and now he can realize that the true concept of success is nothing but to attain God's pleasure by fulfilling the demands of his unique position in this world. 

This can further be elucidated as: a man who serves God's will by maintaining the delicate balance between the demands of his material and spiritual aspects of life and tries to maintain peace and order within his own self and in the society around him, and in the process earns God's pleasure and rewards, both in this world and the hereafter, is really and truly successful. 

On the contrary, a person who fails to acknowledge God's favour of life and indulges in rebellion against his own true nature, and in the process creates disturbance and chaos within himself and the society around him, thus earning God's wrath and punishment, both in this world and hereafter, is really and truly unsuccessful. 

Of course this balanced concept of success cannot be conceived without the clear concept of life  Hereafter. Man is not destroyed after death but is transferred into

another life wherein he has to face the full consequences of his earthly sojourn so that full justice can be done and no criminal escapes the fruits of his misdoings and everyone gets what is his due. 

This is the true concept of success which grants honour and dignity to Man's life, sets a proper direction for each of his actions, makes him a responsible and compassionate being, helps him to lead a more complete and a meaningful life based on firm foundations and permanent values and transforms his journey of life in to a purposeful endeavour. So, now let every soul decide what it wants it's future to be!

Medical Ethics in Islamic History

-Dr. Md. Habeeb Haris 

The expression “medical ethics” was not coined until 1803, when Thomas Percival (1740–1804), a physician from Manchester, England, introduced it in his eponymous book Medical Ethics and created one of the first modern codes of medical ethics. 

However, even from the earliest times, the Muslim Physicians gave utmost importance to ethical medical practice. The Muslim health care professionals cannot restrict themselves to just the Western conception of Medical ethics. They need to fulfil the Islamic ethical requirements too to harmonise their professional lives with the wider Islamic worldview. Islamic medical history is full of writings on 'Akhlaq al Tabib' (Etiquettes for Doctors) by many well-known physicians and scholars of Islamic civilisation. Below are mentioned some examples.

1. Abu Bakr Al-Razi: He wrote a special book one thousand years ago under the title Akhlaaq al-tabeeb (Ethics of the physician). It is an epistle addressed to

some of his students. Here are some excerpts:

“A physician should be gentle with people, refrain from talking ill about them in

their absence, and keep their secrets. A person may be afflicted with a

disease which he keeps secret from the closest people to him, such as his

father, mother, and children. He hides it from those close to him and, out of

necessity, reveals it to his doctor. If the physician treats one of a man’s women

folk, girls, or boys, he should cast down his eyes and not look beyond the

afflicted part of the body.” [from WHO document on Islamic code of medical and health ethics https://applications.emro.who.int/docs/em_rc52_7_en.pdf]

"The physician’s duties to the patients: The first of which is to treat the patients kindly, not to be rude or aggressive, but should be soft-spoken, compassionate, and

behave modestly. 
The physician should inspire the patients even those who have no hope for recovery. 
To treat patients equally regardless of their wealth or social status. 
The aim of the physician should not be the money he will get after treatment, but the cure. Doctors should be even keener on treating the poor and needy than the rich and wealthy."

2. Ishaq bin Ali al-Ruhawi: One of the earliest and most thorough books on medical ethics is “Adab al-Tabib” (Practical Ethics of the Physician) by Ishaq ibn Ali al-Ruhawi, a contemporary to Abu Bakr Al-Razi and lived in the second-half of the ninth century C.E. This book was translated to English by Martin Levey in 1967.

A glance at the chapter titles in Adab al-Tabib will reveal how thorough and comprehensive this book is:
1. The loyalty and faith in which a physician must believe, and on the ethics he must follow;
2. Care of the physician’s body;
3. What the physician must avoid and beware of;
4. The directions of the physician to the patients;
5. The behavior of the patient’s visitors;

6. The simple and compound drugs, which a physician must consider;

7. What does a physician ask the patients or others;
8. The necessity for ill and healthy people to have faith in the physician;

9. The agreement that the patient must follow the instructions of the physician;

10. The behavior of the patient with his servants;
11. The behavior of the patient with his visitors;

12. The dignity of the medical profession;

13. The people must respect a physician according to his skills;

14. Peculiar incidents concerning physicians;

15. Medicine must be practiced by those who have a suitable nature and

moral character;
16. Examination of physicians for accreditation;

17. The kings may remove corruption of physicians and guide the people to proper medicine;

18. The necessity of warning against quacks who call themselves physicians;

19. Faulty habits of people, which may hurt them;

20. What a physician must observe during periods of health in order to prepare for periods of illness.
['Islamic medical ethics a thousand years ago' - Saudi Med J 2013; Vol. 34 (7)]

3. Salah Al-deen bin Yusuf: An ophthalmologist from Hama, Syria, seven

centuries ago wrote in his book Noor al-'uyoon wa jami' al-funoon, (a book

of ophthalmology) giving advice to every student of medicine studying under

him:

“You should know that this industry (profession) is a gift from God, the Most Sublime, given to the person who deserves it, as he becomes the intermediary between the

patient and the Most Glorious and Sublime Lord in seeking recovery. When it is achieved through him, he gains the ample respect of people, is glorified by

them, gains renown within his industry, wins confidence in the decisions he

makes, and receives in the Hereafter a reward from the Lord of Creation.

This is because the benefit that is extended to God’s creatures is something great,

particularly when it is a benefit to poor, helpless people. In addition, you acquire a refinement of manners and moral standards, a generous and sympathetic nature.

You should, therefore, put on the gown of purity, virtue, innocence, compassion, and mindfulness of God, the Most Sublime, particularly when you deal with female family members.

You should keep their secrets, cherish proficiency and religiousness, dedicate yourself to your work in science, renounce physical desires, keep company with scholars and learned people, attend to your patients, feel eager to give them proper treatment, and be resourceful in seeking to cure them.
Moreover, if you can assist the weak with your own money, do it.”
[from WHO document on Islamic code of medical and health ethics https://applications.emro.who.int/docs/em_rc52_7_en.pdf]

4. Ali b. Sahl Rabban Al-Tabari: The court physician of Abbasi Caliphs al-Mu'tasim and al-Mutawakkil, described the Islamic code of ethics in his book 'Firdous Al Hikma' ('The paradise of wisdom' - completed in 850 C.E., is the first ever Medical encyclopaedia written, which incorporates all the then available branches of medical science) stressing on good personal characters of the physician, the physician’s obligations towards his patients, community and colleagues.

He stated: 
“The physician should be modest, virtuous and merciful.
He should wear clean clothes, be dignified, and have well-groomed hair and beard. He should select his company to be persons of good reputation.
He should be careful of what he says and should not hesitate to ask forgiveness if he has made an error.
He should be forgiving and never seek revenge.
He should be friendly and a peacemaker.
He should avoid predicting whether a patient will live or die, only Allah knows.
He ought not loose his temper when his patient keeps asking questions, but should answer gently and compassionately.
He should treat alike the rich and the poor, the master and the servant.
God will reward him if he helps the needy.
He should be punctual and reliable.
He should not wrangle about his fees. If the patient is very ill or in an emergency, he should be thankful, no matter how much he is paid.
He should not give drugs to a pregnant woman for an abortion unless necessary for the mother's health.
He should be decent towards women and should not divulge the secrets of his patients.
He should speak no evil of reputable men of the community or be critical of any one's religious belief.
He should speak well of his colleagues.
He should not honor himself by shaming others.” 
(Al-Tabarī, Firdaws al-hikma fī al-tibb, Frankfurt am Main: Institut für Geschichte der Arabisch-Islamischen Wissenschaften, 1996, “Islamic Medicine”, 29.)

In summary, the Muslim health care professionals need to take inspiration from the Islamic conception of Medical ethics and etiquettes formulated by our great predecessors - our Fuqaha and Hukama.  

           
                                                
                    The cover page of al-Tabarī’s book Firdausu’l-Hikmat in Latin letters, published in Berlin in 1928 by M. Z. Siddqi.

The Oath of a Muslim Doctor

Various principles and values stated in numerous oaths and declarations form the basis for ethical practices in health care. The Hippocratic Oath is but one of these many oaths and declarations that have been recited by entering and newly graduated physicians over the centuries. 

The Muslim physicians cannot restrict themselves to just the Western Medical ethics. They need to fulfil the Islamic ethical requirements too to harmonise their professional lives with the wider Islamic worldview. 

For this purpose, the First International Conference on Islamic Medicine held in Kuwait in January 1981 published the oath of Muslim doctor which says:

The Oath of a Muslim Doctor:                                                               

In the name of Allah, Most Gracious, Most Merciful.
Praise to Allah, the Sustainer of His Creation, the All-Knowing.
Glory to be Him, the Eternal, the All-Pervading.

"O Allah, Thou art the only Healer, I serve none but Thee, and, as the instrument  of Thy Will, I commit myself to Thee.
I render this Oath in Thy Holy Name and I Undertake:

To be the instrument of Thy Will and Mercy, and, in all humbleness, to exercise justice, love and compassion for all Thy Creation;

To extend my hand of service to one and all, to the rich and to the poor, to friend and foe alike, regardless of race, religion or color;

To hold human life as precious and sacred, and to protect and honor it at all times and under all circumstances in accordance with Thy Law;

To do my utmost to alleviate pain and misery and to comfort and counsel human beings in sickness and in anxiety;

To respect the confidence and guard the secrets of all my patients;
To maintain the dignity of healthcare, and to honor the teachers, students, and members of my profession;

To strive in the pursuit of knowledge in Thy name for the benefit of mankind and to uphold human honor and dignity;

To acquire the courage to admit my mistakes, mend my ways and to forgive the wrongs of others;

To be ever-conscious of my duty to Allah and His Messenger (PBUH), and to follow the precepts of Islam in private and in public.

O Allah grant me the strength, patience and dedication to adhere to this Oath at all times”. 


                                 

How Early Islamic Science Advanced Medicine: National Geographic Magazine

Acknowledgement of the great achievements of Muslim Physicians in Medical science by the National Geographic Magazine:

Below are two excerpts from an article BY VÍCTOR PALLEJÀ DE BUSTINZA titled 'How Early Islamic Science Advanced Medicine' that appeared in the November/December 2016 issue of National Geographic History magazine.

How Early Islamic Science Advanced Medicine

"The growth of Islam in the seventh century sparked a golden age of scientific discovery. Building on the wisdom of ancient civilizations, Muslim doctors pushed the boundaries of medical science into bold new places."

"Physicians from Islamic countries during the late Middle Ages enjoyed great respect. Their reputation was well deserved, for the study and practice of medicine was then led by Muslim societies across their immense territory, which extended from modern-day southern Spain to Iran."

See full article at below link:
https://www.nationalgeographic.com/history/history-magazine/article/muslim-medicine-scientific-discovery-islam

Islamic Guidelines for Health care Professionals

-Dr. Md. Habeeb Haris (Senior Consultant Radiologist and Alim Graduate)

Islam is not just a collection of beliefs and rituals. It is a perfect Deen which guides humanity in every aspect of individual and collective life - including the Spiritual, Philosophical, Moral, Social, Economic, Cultural and Political aspects. The modern materialistic way of medical practice has taken out God completely from the process of Healing, whereas Muslims are required to put God and His Guidance at the centre of their lives. A Muslim is obligated to follow Islamic guidelines concerning his life in it's totality, including his profession and occupation. 

The Quran says: 
"O you who have believed, enter into Islam completely [and perfectly] and do not follow the footsteps of Satan. Indeed, he is to you a clear enemy." (2:208)

"It is not fitting for a believer, man or woman, when a matter has been decided by God and His Prophet, to have any option about the decision. If anyone disobeys God and His Apostle, he is indeed on a clearly wrong path." (33:36)

Since Islam gives much importance to the practice of Medicine for the benefit of humanity, it gives many guidelines and regulations regarding it. A Muslim doctor, nurse or health care worker is obligated to learn about those guidelines and follow them in their routine practice. Failure to do so will make him/her answerable before Allah.

Below are given some important Islamic guidelines to be followed in patient care.

-Get Proper Qualification and Training:

There is no place for quackery in Islam.

Mufti Abu Bakar Qasmi writes, "The basic condition for any action to be performed in the Shari'ah is ‘ability and qualification/eligibility’. Any act performed without qualification and eligibility and the required ability is, in any case, unlawful, even though it, by chance, brings a good result.

The Prophet ﷺ said: “Judges are of three kinds: One of them is promised Paradise and the other two are promised Hell. He who is aware of the truth and delivers the judgement accordingly belongs to Paradise. Second judge is the one who knows the truth but gives the verdict wrongly. He will be thrown into Hell. Third judge is he who is unaware of the fact; still, he continues the job of Qaza (judiciary), he is also a man of Hell.” (Abu Dawud: 3573)

Just as the rights of the people are dependent on the office of the Qazi (judge), so is the life and health of the people related to the Medical treatment. That is why ability, eligibility, qualification and appropriate skills are also necessary for the profession of medicine." (Jadeed Tibbi Masail)

The Messenger of Allahﷺ said: Anyone who practises medicine when he is not known as a practitioner will be held responsible. (Abu Dawud: 4586, Nasai: 4830, Ibn Majah: 3466, Mishkaat: 3444 chapter on qisas) 

The Messenger of Allah ﷺ said: Any physician who practises medicine when he was not known as a practitioner before that and he harms (the patients) he will be held responsible. (Abu Dawud: 4587)

Hadhrat Omar bin Abdul Azeez (RH) says: “One who undertakes any task without knowledge brings more harm and less benefit.” (Al Ibanah: Hadith No. 570) 

Hence it is important to practice in one's own field of qualification in which one has proper training and skills.

This also includes the need for constantly updating one's medical knowledge and skills according to the latest research so that one doesn't prescribe outdated or discarded treatments.

-Acquire the Necessary Knowledge of Fiqh Concerning your Medical Practice:

It is Fardh e Ain (Individually obligatory) on all medical students and practitioners to acquire the knowledge of fiqh concerning medical issues. The Islamic Shariah has defined the limits of permissibility for the ways of cure and medical treatment. But most Muslims, including many who are religious, do not take care to find out if the particular medical treatment is lawful or unlawful. It seems as if the physicians and the patients both have got exemption from the dictates of Shariah. There are some forms of treatment and surgical procedures that are prohibited in Islam. Also some procedures are only conditionally allowed. There are also many shariah guidelines regarding patient interaction, gender rules, handling of cadavers during Anatomical dissection and Autopsy, forms of earnings of doctors, interaction with other colleagues, rules of employment, insurance, commission, etc. Failure to learn about these rules of Shariah will lead one to commit sins.

Umar bin Al-Khattab [may Allah be pleased with him] said:

"No one should buy/sell in our markets except one who has understanding of the religion." (Tirmidhi: 487)

Sincerity and dedicated service without proper knowledge of Shariah can be counter-productive. Doctors should be in touch with expert, experienced, authentic and pious Ulama to help them in learning the rulings concerning medical practice, medical ethics, and permitted and prohibited forms of earning money. This is how they can protect themselves from unlawful earnings and serve the people in accordance with the injunctions of Shariah. The company of Ulama is also essential for enhancing one’s spirituality and attaining high moral character and balance in one’s life. Distancing oneself from the Ulama is a frequent cause of misguidance and deviation from the correct understanding and practice of the religion.

-Proper Niyyah (Intention):

In order to get the proper mental orientation and acquire spiritual benefits from his clinical work, the doctor should make the niyyah (intention) of treating the sick for the pleasure of Allah and relieving their sickness and pain and also recall the ahadeeth on the rewards for patient care when seeing any patient or at least while going to the clinic/hospital at the beginning of the day and also seek Allah’s help in performing the duty properly.

The Messenger of Allah ﷺ said: "Actions are according to intentions, and everyone will get what he intended." (Bukhari & Muslim)

Imagine how much our approach and behaviour with the patients will change if we start seeing everyone of our patients as an opportunity to earn limitless rewards from Allah and Duas of the Angels instead of seeing them as mere customers or financial opportunities!

Mufti Taqi Usmani writes: "Intention is reflected in action and behaviour: So, intention is what makes the difference. The good intent is reflected in the action. One can claim that his intention is good, but the real intention is observable in one’s own actions. If his intention is to serve humanity, his approach and style of working will be totally different from the one whose intention is only to earn. Such a person will have sympathy in his heart and would feel the pain of others. His interaction with patients with kindness will show what he has in his heart." (‘Al-Balagh’ magazine, February-2019 issue)

Working with a Higher Purpose: 

Working with a higher purpose in mind is linked to having the correct Niyyah. Think about the broader impact your work has and focus on its positive effect on others.

Apart from the benefits in the Hereafter, such an approach has clear professional benefits. In a study of hospital cleaners, those who saw their role as helping patients felt greater job satisfaction in their roles. (The study was published by American Psychological Association in 2013 - https://justinmberg.com/berg-dutton--wrzesniewski_2.pdf )

-Speak Positively, Give Hope and Cheer up the Patient:

It's the duty of the physician to give hope to the patients and put them at ease by relieving their anxiety. Even if there is bad news to be communicated to the patient or his relatives, it should be done in a very considerate and soft way with wisdom, keeping in mind their emotional state.

The Prophetﷺ said: "If you visit a sick person, then try to put him at ease by giving him hope (of prolonged life), for it does not change anything, but relaxes (and comforts) him." (Ibn Majah & Tirmidhi).

And he ﷺ used to say to the sick, “Do not worry. It (i.e., the sickness) will be a purification (for you), Allah willing." لاَ بَأْسَ طَهُورٌ إِنْ شَاءَ الله (Bukhari).

-Excellence of Character and Morals (Akhlaq) with the Patients, their Relatives and your Colleagues:

This is an important and indispensable quality for all Muslims but definitely is more necessary for the physicians and health workers. One should always greet the patients with a smile. The correct intention teaches a doctor that it is his duty to deal with the patients with patience, good manners, integrity and kindness. His service cannot become worship unless he develops such qualities. A doctor or nurse with a foul mouth and rude/arrogant behaviour cannot earn the trust of his/her patients or their relatives. 

The Prophetﷺ said: 

“The believers whose faith is most perfect are those who have the best character.” (Ahmad)

"The best amongst you are those who have the best manners and character." (Bukhari: 3559) 

“Whoever does not show mercy to our young ones, or acknowledge the rights of our elders, is not one of us.” (Musnad Aḥmad: 7073) 

“He is not one of us who is not merciful to our young, nor respects our elders…” (Tirmidhi: 1921)

- Avoid speaking on the phone or checking social media accounts during patient consultations. It will irritate the patient and reflect a non-serious attitude, causing the patient to lose confidence in the treatment.

-Patience (Sabr) and Forbearance:

A healthcare practitioner has to tolerate the improper behaviour of his/her patients and excuse the annoyance of patients considering their pain and illness. 

Mufti Abu Bakar Qasmi writes, "During his practice, a physician has to face different kinds of people with various temperaments. Some of them will be uneducated or ignorant or impatient or short-tempered. Sometimes they may say harsh words and hurl bad comments at him. Allah has instructed those with great responsibilities and noble professions to show patience and perseverance on such occasions.
'If you observe patience and fear Allah, then this (observance) is among the matters of firm resolution.' (Quran 3:186)" (Jadeed Tibbi Masail)

The physician should also have patience while taking history and examining the patient. He should give time to the patient to explain about his illness properly. Otherwise he may feel dissatisfied with the doctor and unconfident about his treatment. It will also negatively affect patient compliance with the prescribed treatment.

-Treat Others the Way You Would Like Others to Treat You:

The Prophet ﷺ said: None of you [truly] believes until he loves for his brother that which he loves for himself. (Bukhari, Muslim)

This is a golden rule to follow in dealing with patients and colleagues as it will automatically help one to be his best self in his practice and protect him from double-standards, selfishness and injustice. One should strive to offer the same care and kindness to all the patients as one would give to one's own close relatives. 

-Avoid Treatments which have More Harm than Benefit:

The clinician must carefully consider the risk versus benefit before prescribing treatments which can have significant adverse effects on the patient. Harmful, aggressive, overly painful and invasive treatments should be avoided as much as possible. 

"The Prophet ﷺ forbade from cures that are Khabith." [Abu 'Eisa said:] Meaning poison (Tirmidhi: 2045)

The Prophet ﷺ said: “There should be neither harming nor reciprocating harm.” (Ibn Majah, Al-Daraqutni and Malik)

-Avoid Prescribing Medicines with Haram ingredients:

Prescribing or using medications containing Haraam ingredients is a serious matter in shariah. 

The Prophet ﷺ said: “Allah has sent down the disease and the remedy, and He has created for every disease a remedy, so treat disease but do not treat it with anything that is haraam.” (Abu Dawud: 3874)

Someone asked the Prophet ﷺ permission to take alcohol as a treatment. So the Prophet ﷺ said: "It is certainly not a treatment, rather, it is a disease." (Tirmidhi: 2046)

The Messenger of Allah ﷺ prohibited unclean medicine. (Abu Dawud: 3870)

Conditions for using medicines that have impure and unlawful substances in them:

Mufti Muhammad bin Adam al-Kawthari
 says: It will be permissible to use medicines that have impure and unlawful substances in them, provided the following conditions are met:

1) It is reasonably known that the medicine will be effective, and is needed to treat the disease;

2) There is no permissible alternative reasonably available;

3) This has been established by an expert Muslim doctor who is at least outwardly upright and god-fearing. (https://daruliftaa.com/food-drink/medicines-with-gelatine/)

Keeping in mind these conditions, the use of vitamin supplements, enzymes, hormones etc., containing gelatine or pork or non halal/non zabiha animal derivatives should be done very carefully. 

-Lower the Gaze and Follow Gender and Satr rules:

"Tell the believing men to lower their gaze (from looking at forbidden things), and protect their private parts. That is purer for them. Verily, Allah is All-Aware of what they do. And tell the believing women to lower their gaze (from looking at forbidden things), and protect their private parts (Quran 24:30-31)

The Prophet ﷺ said: A man should not look at the awrah (Satr) of another man and a woman should not look at the awrah of another woman. (Muslim).

“Modesty is part of faith (iman).” (Bukhari & Muslim)

The Prophet ﷺ said: Do not uncover your thigh, and do not look at the thigh of the living and the dead. (Abu Dawud: 4004)

The Prophet ﷺ said regarding the males: "What is between the navel and the knees is awrah (Satr)." (Ahmad, Abu Dawud and al-Daraqutni). 

The Prophet ﷺ warned: "If one of you were to be stabbed in the head with an iron needle, this would be better for him than if he were to touch a woman whom it is not permitted for him to touch." (Narrated by Tabarani; it is a sahih hadith).

Abdullah ibn Mas'ud رضي الله عنه went to visit a sick person with some other people. There was a woman in the room and one of the men began to look at her, 'Abdullah said to him, 'It would have been better for you if your eyes had been gouged out.' (Adab al Mufrad of Imam Bukhari)

It’s important to follow the Islamic rules of uncovering of Satr / Awrah of the body, gender interaction and Islamic modesty with the patients and their attendants and other staff. If the Islamic rules of modesty are not followed, one will earn more sin than money through his medical practice and the sin of seeing the impermissible will destroy his spirituality and moral well being.

In cases of necessity, things that are ordinarily forbidden are permitted. The scholars are agreed that it is permissible for a male doctor to look at the site of illness in a woman when necessary, within the limits set by shariah. Similarly, a male doctor may look at the Satr of a sick man. But he should look at the site of the complaint only as much as is necessary (and no more). 

As far as possible, the male physicians or technicians should not be assigned to the female patients if female staff (of reasonable competence) are available, particularly if it involves seeing or touching the areas of Satr.

A male and a female should not be together in seclusion (Khalwah) in the hospital too as elsewhere (care should be taken to avoid this specially during night duty or in Operation Theater, etc.)

One should not expose the Satr (minimum concealable part of the body defined in Shariah) of the patient with out a valid need. The doctors should see the portion of the Satr parts of the body only as much as needed. For, it is unlawful to expose these parts and see them in other situations.

Particular care should be taken to assign same sex nurses and other staff for the patients who need exposure and handling of private parts, like inserting urinary catheters, changing diapers, etc.

Also, during the medical procedures and in the Operating Room, the patient's Satr should be exposed to the extent necessary only before the medical staff of same sex who is responsible for preparing the patient for it. Other staff should be called in after properly covering the rest of the body. Those who are not actually performing or assisting in the procedure should not see the exposed body of the patient. 

The Satr of a dead body is the same as for living people. It should be respected too.

The lady doctors and other female staff should follow the Shara'i Pardah/Hijab rules in their dress and behaviour. Their hospital and OT dress should be in such a way that it covers their Satr fully. Their scrubbing and dressing area should be separate from male areas. Unnecessary interaction with male staff should be avoided.

The managements of Muslim owned hospitals/clinics have a responsibility to apply and encourage these rules in their setups and educate and sensitise the staff to these rules.

For detailed explanation of Satr rules see: 
https://seekersguidance.org/answers/hanafi-fiqh/a-detailed-exposition-of-the-fiqh-of-covering-ones-nakedness-awra/

-Explain the Muslim Patient if the Disease or Treatment Impacts his Acts of Worship:

Explain the modifications needed in Ghusl, Wudhu, Tayammum, Salah, Fasting, etc., due to the medical need.
Do not make exemptions or modifications unless really required. To be able to properly advise the patient, doctors need to learn the relevant Fiqh.

Mufti Abu Bakar Qasmi writes, "It is compulsory for a Muslim Physician to know the instructions and commandments regarding various acts of worship and the relaxations given for the sick. Since, sometimes, people suffering from illness ask the doctors some rulings concerning acts of worship which relate to health or illness. The lack of knowledge may cause the physician and the patient both to commit the things prohibited by Shariah." (Jadeed Tibbi Masail)

-Respect the Patient’s Appointment Time and Refrain from Making Them Wait for a Long Time:

Every effort should be made to have proper, well organised appointment schedules for the patients and not to inconvenience them by making them wait for a long time for consultations, tests and procedures. 

-Duas while Visiting the Sick and Dua for the Sick:

The Messenger of Allah ﷺ said, 'When you are with a sick person or dead person, speak well. The angels say 'Ameen' to what you say.' (Muslim)

There are many Sunnah Duas that can be read for the benefit of the patients such as:

أَذْهِبِ الْبَأْسَ رَبَّ النَّاسِ وَاشْفِ أَنْتَ الشَّافِي لَا شِفَاءَ إِلَّا شِفَاؤُكَ شِفَاءٌ لَا يُغَادِرُ سَقَمَاً

Take away the hardship, O Lord of mankind, give shifaa, You are the One who cures, there is no shifaa except Your shifaa, a cure that will not leave any sickness. (Bukhari & Muslim).

Or one can say seven times أَسْأَلُ اللَّهَ الْعَظِيمَ رَبَّ الْعَرْشِ الْعَظِيمِ أَنْ يَشْفِيَكَ

“I ask Allah the Exalted, the Lord of the Great Throne, to heal you.” (Tirmidhi)

A Muslim physician should seek Allah’s help while providing treatment to the patient and start his work with ‘Bismillah’ (in the name of Allah), because nothing happens without Allah’s Will. This will infuse his heart with satisfaction and peace and he will find that Allah is helping him in his work instead of solely relying upon his own experience and skill. This will also increase his certainty and trust in Allah (Yaqeen and Tawakkul).

The doctor should maintain the quality of humility and should be grateful to Allah that He has selected him for this noble profession and remind himself that it's only Allah Who cures the patient. It does not suit a physician to be over confident on his own capability, skill, experience and knowledge. If one relies only on himself, Allah will deprive him of His blessings and help, leaving him alone with no Divine help and guidance, making him incapable of achieving much. Reading the Duas regularly during one's clinical work will help correct one's orientation too and avoid the feelings of arrogance from developing in one's heart.

-Ask the Muslim Patient to Pray for You:

The Prophet  ﷺ said: "If you enter upon a sick person, then ask him to supplicate for you, for his supplication is like the supplications of the angels." (Ibn Majah).

The beautiful spiritual relationship that Islam establishes between the doctor and the patient is based on mutual well-wishing, sincere concern and care. In this, the doctor prays for the health of the patient and also requests the patient to pray for him! Can such a doctor ever exploit or harm the patient or even treat him carelessly?

This is in complete contrast to the mere commercial relationship it has been reduced to by the materialistic corporate healthcare industry today.

-Spiritual Counselling and Dawah to Patients:

A health care provider is generally trusted by the patients and his family and his/her words can have an impact on them. They should use this opportunity to explain the spiritual aspects of illness and seeking cure according to the Islamic teachings and cure their spiritual diseases along with physical diseases and bring the patient closer to Allah. There is a need to spiritualise the process of medical treatment and approach it as a way of holistic Healing. The patients learn their approach to disease and treatment from the doctors' words, behaviour and approach. If doctors ignore God in all this, then the patients too will adopt a soul-less, materialistic and mechanical approach to their treatment, ignoring the need for spirituality and invoking God for their healing. And this has an impact on the wider society too. The way the society views disease and the process of cure has to be brought in line with the Islamic Aqeeda and Spirituality. 

-Avoidance of Trivialities and Pettiness:

Hadhrat Umar Farooq (RA) used to say, “We used to leave out ninety percent of lawful things because of the fear of falling into unlawful things.” (Ihya Al-Ulum of Imam Ghazali: 95/2)

Shaikh Dr. Rafaqat Rasheed says, "It's not appropriate for a healthcare practitioner to indulge in affairs that are religiously repugnant or socially reprehensible, like backbiting, tale-bearing, talking too much, arguing, laughing too much, or saying socially unacceptable words - especially while performing his/her duties.
It’s preferable to refrain from all such acts that are against decency or reflect a non-serious attitude, though they may not be religiously prohibited, such as chewing gum while working, untidy appearance, wearing strange and socially unacceptable clothes, indecency, undignified behaviour."

Similarly, one should avoid talking too loudly, watching social media clips, listening to music, frequent texting, unnecessary frequent or long phone calls in the hospital.

-Community Health Education:

Consider public health through health education that is suitable for the practitioner’s area of influence, to endorse or contribute to the preventive programs, and the protection of the environment. Recognize that the community and environment are important factors in the health of individuals by helping the community to deal with the social and environmental determinants of diseases.

-Adhere to the Medical Ethics:

The Muslim physicians cannot restrict themselves to just the Western Medical ethics. They need to fulfil the Islamic ethical requirements too to harmonise their professional lives with the wider Islamic worldview.

The Islamic Medical Ethics consist of responsibilities:
1. Towards Patients

2. Towards the Community

3. Towards Professional Colleagues 

4. Towards Him/Herself 

5. Towards God- by following the Religious Rulings

Ethical practise not only benefits the patients, it benefits the medical practitioners and hospitals too.

Studies suggest that by practicing Medicine with a clear moral compass physicians and other healthcare professionals also potentially benefit, because of the increased professional job satisfaction and reduced physician burnout.

The Mayo Clinic Proceedings published an article with the title, "Ethics and Values in Clinical Practice: Whom Do They Help?" It says in conclusion:

  "The title of this article asked who benefits from an ethical and values orientation in health care. Patients clearly do. Physicians, other health care professionals, and health care organisations also potentially benefit, but not only because of the satisfaction of conducting themselves in a professionally ethical manner. These groups will benefit by reducing burnout and its personal and professional consequences if attention to health care ethics and values reduces the realities or the perceptions of “incongruence” in these areas between health care professionals and the health care organisations with which they are associated."

(Mayo Clin Proc. 2011 May; 86(5): 421–424.)

-Serving the Deen and Providing Intellectual Leadership to the Community:

The Medical professionals are considered among the intellectual elite of the community, so their responsibilities to the community and Deen extend beyond the Medical profession. They may use their intellectual abilities to acquire a deeper knowledge and understanding of Islam from reliable scholars and educate the other educated Muslims and youth in Islamic values and ideology.
They can provide leadership to the community in various fields. They can help in defending Islam from the various ideological attacks in the present times.  

May Allah grant us the strength, patience, awareness and dedication to adhere to the Shariah guidelines at all times of our career. Aameen.

Does Islam Permit Hypnosis (Hypnotherapy)?

Some people adopt treatment through Hypnosis. During hypnosis, a trained hypnotist or hypnotherapist induces a state of intense concentration or focused attention. This is a guided process with verbal cues and repetition. The trance-like state a person enters may appear similar to sleep in many ways, but he is fully aware of what is going on. A person can attain self control through it, hence it is used to control cigarette addiction, mental diseases, insomnia, depression, etc.

Procedure Details

What typically happens during a hypnotic session?

According to the website of Cleveland Clinic, USA, There are four stages of hypnosis: induction, deepener, suggestions and emergence.

Induction

During this stage, you begin to relax, focus your attention and ignore distractions. Your hypnotherapist will guide you through this stage with specific techniques such as controlled breathing (breathing in over a count of seven, then breathing out over a count of 11), or progressive muscle relaxation (tensing muscles as you breathe in and relaxing muscles as you breathe out, then repeating in a certain order of muscle groups throughout your body) or focusing on a visual image.

Deepener

This stage continues the first stage, taking your relaxation and focus to a deeper level. This step often involves counting down or using similar descending imagery such as walking down stairs or slowly sinking deeper and deeper into a comfortable bed. These first two stages are aimed at easing your openness to suggestions.

Suggestions

This is the stage for actual change in experience, behaviour or perception. Your hypnotherapist will use imagery and carefully chosen language. The suggestions are usually symptom focused (to resolve a symptom) or exploratory (to explore experiences associated with the start of symptoms). Suggested changes may be in perception, sensation, emotion, memory, thought or behaviour.

Example: To quit smoking, you’ll learn to identify your triggers to want to smoke, learn positive ways to change, understand resources to effect change, disrupt your pattern, attach a better response, notice the difference and install the changed behaviour. You may be encouraged to see your “old” self with black lungs in a mirror behind you and see your “new” healthy self with clean lungs in a mirror in front. You’ll then be guided to choose which self you like and to walk toward that self.

Emergence

During this stage, you come out of hypnosis. Your hypnotist may use reverse deepeners, such as giving you the suggestions that you’re climbing up stairs or counting up.

Islamic guidelines on Hypnosis:

According to most scholars, it is permissible to use hypnotherapy for a Ja’iz (permissible) objective as long as the process doesn't involve anything contrary to Islamic values. Likewise, a Muslim may go to a non-Muslim hypnotist on the condition one is not made to do anything which is not allowed in Islam.

Mufti Ebrahim Desai of Darul Ifta, South Africa says:
“It is permissible to use hypnosis to aid one to quit smoking. One may go to a non-Muslim hypnotist on the condition one is not made to do anything which is contrary to Shariah.” (https://askimam.org/public/question_detail/15342)

Some scholars have issued fatwas that the issue of hypnosis is related to the use of the jinn or magic. If some one practices such a methodology to induce hypnosis then it will be Haram.

Also, if hypnosis is used as a kind of deception in agreement with some of the attendees, especially in public places, to eat people’s money unjustly and to earn fame, it would be Haram.

To summarise, If hypnotherapy is used as a means of cure and there is nothing contrary to Islam in the therapy, then it is permissible. If it is used for evil purposes, or involves prohibited things in the method, then it will be impermissible.

Diabetes and Fasting - Medical and Fiqh Guidelines

Diabetes and Fasting 
-Dr. Mohd. Habeeb Haris MD (Consultant Radiologist and Alim graduate)

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterised by sustained high blood sugar levels.

Fasting in Ramadhan is one of the five pillars of Islam and is an obligation on all adult Muslims in general, unless they have a valid Shara'i excuse. Fasting can be accompanied by significant changes in: both energy and nutritional intake; in the diet composition; in the working hours; and the usual way of life, which can cause significant metabolic and physiological changes to occur, leading to significant impact on the management and complications of diabetes. The drug doses and timings also would need to be altered.

Diabetic patients are at a high risk for development of a wide range of potential fasting-related complications such as dehydration, hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). It should not be overlooked, however, that fasting can be quite beneficial for certain diabetic patients provided that they strictly adhere to the evidence-based guideline and pious physicians’ advice. [Effects of Ramadan Fasting on Social, Psychological and Physical Well Being to Health. International Journal of Contemporary Microbiology. 2015;1(2):25–29]

Current world data show that 4 Muslim-majority countries are ranked within the top 10 diabetes worldwide prevalence. These countries are Pakistan (prevalence 30.8%; rank 1), Kuwait (prevalence 24.9%; rank 2), Egypt (prevalence 20.9%; rank 8), and Qatar (prevalence 19.5%; rank 10).
[Wisevoter, “Diabetes rates by country 2023- wisevoter,” 2023, https://wisevoter.com/country-rankings/diabetes-rates-by-country/]

Since a significant number of Muslims globally have diabetes, many of whom would be fasting in Ramadhan every year, the medical professionals need to be aware of their specific medical needs and the need for providing appropriate medical guidance to such patients. The most important of this is to answer the question - can the diabetic patient safely fast or not?

It's important to correctly guide these patients, based on sound medical evidence and Islamic requirements. If the doctor goes overboard and prevents all diabetics from fasting, he will be answerable to Allah for preventing people from carrying out an important religious obligation. And if he allows even high risk patients to fast due to religious zeal, he will be legally and morally responsible for any complications the patient may suffer due to it. 

Ultimately, it's for the treating physician to advise and assist the patient in deciding whether he should fast or not. However, to assist the doctors in making a sound decision, the International Islamic Fiqh Academy has given certain guidelines. But these are from 2009, and the newer treatment protocols and devices like continuous glucose monitoring devices and Insulin pumps might enable a wider range of diabetic patients to fast safely. 

The main idea behind these guidelines is to categorise the risk of developing serious adverse effects from fasting. 

The treating physicians should keep all these factors in mind and decide for themselves how much to rely on this risk categorisation while advising their patients.

Guidelines of International Islamic Fiqh Academy:

"The International Islamic Fiqh Academy (IIFA) of the Organization of the Islamic Conference, holding its 19th session (in Sharjah, United Arab Emirates, in April 2009) has stated the following (Resolution No. 183 (9/19) regarding diabetes and fasting:

Medical Classification of Diabetic Patients

First Category

Patients with a very high probability to encounter severe complications from fasting, as medically confirmed. The sickness state of a patient of this category falls under one or more of the following cases:

• Patients who face severe hypoglycaemia during the three months preceding the month of Ramaḍān.

• Patients who face repetitive ups and downs in the ratio of blood sugar.

• Patients who encounter the problem of hypoglycaemia unawareness (loss of symptoms of hypoglycaemia), a state which occurs in some diabetic patients, especially those who are classifiable under type I who face repetitive hypoglycemias for long periods.

• Patients who are known for facing difficulty in controlling diabetes for long periods.

• Cases of “Diabetic Ketoacidosis” complication or (Diabetic Coma) complication.

• Patients of diabetes type I.

• Patients who suffer from other severe diseases that accompany diabetes.

• Diabetic patients who have to do work that require hard physical effort.

• Diabetic patients who undergo dialysis.

• Diabetes during pregnancy.

Second Category

This category includes patients who have a relatively high probability of encountering complications on fasting according to the most-likely opinion of physicians. The sickness status of these patients falls under one or more of the following cases:

Those who suffer high levels of blood sugar as when the level of glycated hemoglobin (HbA1c) exceeds 10%.

Those who suffer renal insufficiency.

Those who suffer large artery diseases (such as cardiovascular diseases).

Those who live alone and receive medication through injection of insulin or by sugar control medicines, which reduce sugar through stimulation of the insulin producing cells in the pancreas.

Those who suffer other diseases, making them vulnerable to additional risks.

Old patients who suffer other diseases.

Patients who receive medical treatments that affect the brain.


Shariah Rulings regarding Patients in Categories I and II

Cases of these two categories are based on certainty or “high probability” that fasting will cause grave harm to them, as per the judgement of specialised and trustworthy physicians. Therefore, a patient who faces any of the cases cited above for identification of patients in these two categories should not fast. It is not permissible for him to fast in order to avoid inflicting harm upon himself. Allāh the Almighty said, «And make not your own hands contribute to your destruction,» (Al-Baqarah, 195) and He سبحانه وتعالى also said, «Nor kill (or destroy) yourselves for verily Allāh hath been to you Most Merciful.» (Al-Nisāʾ, 29) The treating physicians should explain to patients of these two categories how fasting is risky for them and enlighten them about the high probability that they may face complications which could – most likely – be serious to their health or lives. Physicians should also adopt all possible suitable medical procedures, which could enable the patient to fast without facing harm.

Rulings that relate to non-fasting in Ramadan for sickness excuse shall apply to patients in categories I and II in compliance with the directives of Allāh the Almighty Who said, «But if any of you is ill, or on a journey, the prescribed number (should be made up) from days later and for those who can do it (With hardship), is a ransom, the feeding of one that is indigent.» (Al-Baqarah, 184)

If the doctor (after a thorough medical assessment) warns the patient that there is a high or very high risk of serious complications, then the patient would be sinful for fasting against such advise, but his fasting is valid.

Third Category

These are patients who have the medium probability of encountering complications from fasting. This category includes diabetic patients whose cases are stable and well controlled through suitable medicines that reduce sugar by stimulating the insulin producing cells in the pancreas.

Fourth Category

Patients who have low probability to encounter complications from fasting. This category includes diabetic patients whose cases are stable and well-controlled through diet only or by using medicines that reduce sugar by increasing the efficacy of the insulin in the body without stimulating the insulin-producing cells in the pancreas.

Shariah Rulings Regarding Patients in Categories III and IV

Leaving the Fast during the month of Ramaḍān is not allowed for patients in these two categories since medical findings do not indicate harmful complications that could affect their health or lives. Contrarily, some of these patients could even benefit from fasting. So, they should fast.
Physicians have to stick to these rulings and decide suitable treatment for each case separately.

Recommendations

1. Physicians are required to have a suitable degree of knowledge about Shariah rulings relating to this subject. This necessitates the preparation of such material by relevant bodies and disseminating it among those who need it.

2. Fiqh scholars and Islamic preachers are requested to advise fatwa seekers to consult physicians who know medical and religious dimensions of fasting and who fear Allah the Almighty in providing advice on a case by case basis.

3. Due to the severity and seriousness of dangers that could originate from complications of diabetes in case of fasting, and which could badly affect the health and lives of diabetic patients, guidance and information should be provided through all possible means, including sermons at mosques and through mass media, in order to enlighten patients about the rulings above; raising awareness about the disease and how it can be dealt with is essential to mitigate its effects and make it easy to accept Shariah rulings and medical advice pertaining to it.

4. IOMS, in cooperation with the Academy, should assume the task of preparing an information booklet on this subject in Arabic and other languages (spoken by Muslims) and work for its dissemination among physicians and Fiqh scholars, and make it available online for patients to benefit thereof.

5. Calling upon ministries of health in Muslim countries to launch national programs in areas of prevention, medical treatment, medication and awareness about diabetes and their Shariah rulings." [End of quote from IIFA]

Conclusion:

So, before deciding whether to fast or not, the patient should consult a knowledgeable and God-fearing doctor and also consult a good Islamic scholar, so that a correct decision can be taken from both medical and Islamic perspective.

                       

 Summary chart from Shaikh Dr. Rafaqat Rasheed's lecture on Fiqh of fasting.

Trial Fasting when in doubt:

When there is some doubt on the ability (and safety) of the patient to fast, Shaikh Dr. Rafaqat Rasheed (General Practitioner and Islamic scholar from UK) suggests trial fasting for diabetics and patients of other chronic diseases before the month of Ramadhan (preferably in Shaban) so that they can get an idea if they can safely fast or not. 

Diabetes education and Ramadhan fasting

"In all patients with diabetes, Ramadhan-focused education is of paramount importance for heightening their awareness of the possible associated risks, and formulation of effective strategies to minimise them. High-risk individuals who choose to fast should have access to ample education and support so that the potential risks, particularly those of hyper- and hypoglycaemia can be minimised. It should be emphasised that in all educational programs, optimal blood glucose monitoring should be considered as the principal consideration for minimisation of the risk of complications.

Prior to Ramadan, clinicians should perform a comprehensive evaluation and assessment for all patients with diabetes who intend to fast during Ramadan, and consider individualised approaches for their patients.

Lifestyle and diet modification can be considered as another key component of Ramadan Fasting education in individuals with diabetes. The fasting-feeding nature of the ritual can predispose diabetic patients to hypoglycaemia during the day and hyperglycaemia after iftar at night. In most Islamic cultures, consumption of high-calorie, high-fat, and carbohydrate-rich meals, confectionaries, and beverages is commonplace in Ramadan, which can adversely affect blood glucose levels and increase the risk of development of hyperglycaemia and related complications. This should be strongly discouraged in all educational programs.

Moreover, due to the high risk of hypoglycaemia and dehydration, patients with diabetes should be prohibited from strenuous exercise, particularly late in the evening and before iftar. Patients should also be informed that consumption of large amounts of high glycemic index (GI) carbohydrates and alternations in physical activity and sleeping patterns can lead to weight gain during Ramadan.

 Symptoms of hypoglycaemia and hyperglycaemia should be clearly explained to diabetic patients, and they need to be thought to measure their blood sugar and immediately discontinue fasting if they develop.  They also need to be advised that, in case of hypoglycaemia, a small amount of a fast-acting carbohydrate (a glass of fruit juice) should be consumed, and they need to retest their blood glucose levels again after 20 min."

"Drinking large amounts of water and liquids before dawn (at suhur time) should be discouraged, and instead, moderate and continuous consumption of water and beverages during non-fasting hours should be promoted."

"The advantages of the use of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) systems need to be mentioned to them, so that they procure and use them if affordable.

The type, dose, and timing of the anti-diabetic medications each patient takes is immensely influential in the management of potential risks involved in their use, but most antidiabetic agents used for treatment of type 2 diabetes are generally considered safe. It should be mentioned, however, that in patients who take several glucose lowering medications, the risk of hypoglycaemia may be amplified. Particularly, in patients who take a basal insulin in combination with a DPP4I, metformin, or other glucose lowering agents, the risk of hypoglycaemia can greatly increase."

(Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update

Ali Tootee and Bagher Larijan- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088403/#CR3 -This article has good details about the management of type 1 and type 2 diabetes in fasting. I recommend it to all doctors treating diabetics)

Fiqh Ruling (From 'Islamic guidelines on contemporary medical issues' by Mufti Abu Bakar Qasmi): 

Concession for Diabetic Patients:

If the doctor opines that fasting is harmful for a patient of diabetes, the patient is allowed to skip or break the fast. If Allah grants him health, he must observe the missed fasts later. If there is no hope of recovery, he should pay fidyah for every fast missed.

Diabetes patient can pay the expiation for fast:

If someone is very old and is having uncontrolled diabetes and is medically not expected to be able to fast in the future too, then he/she is allowed to pay the expiation (fidyah) instead of fasting. (derived from Radd Al-Muhtar: 2/427)

Quantity of Fidyah:

The expiation (fidyah) is to give one Sadaqat al-Fitr or its monetary equivalent to the poor for each missed fast. The expiation amount is half saa’ of wheat, which is equivalent to 1 kilogram 574 grams and 640 milli-grams. (Idhah Al-Masa’il: 90)