Dates in Ramadan - The Diabetic Dilemma

- by Dr Habeeb Haris

Dates in Suhoor and Iftar:

It is sunnah to eat dates in Suhoor and Iftar.
“The most excellent pre-fasting meal of the believer is dates.” (Sunan Abī Dāwūd 1399, Grade: Sahih)

The prophetic wisdom of eating dates at Iftar and Suhoor is the ideal biological decision, as fructose (the sugar in dates) maximizes rates of liver glycogen restoration. 

[Conlee RK, Lawler RM, Ross PE. Effects of glucose or fructose feeding on glycogen repletion in muscle and liver after exercise or fasting. Ann Nutr Metab. 1987;31(2):126-32. doi: 10.1159/000177259. PMID: 3592616.]

But the Prophet (ﷺ) would break the fast with water if dates were not available.

Anas bin Malik (RA) narrated:

"The Messenger of Allah would break the fast with fresh dates before performing Salah. If there were no fresh dates then (he would break the fast) with dried dates, and if there were no dried dates then he would take a few sips of water." (Tirmidhi: 696)

The Prophet (ﷺ) even stopped his companions from taking dates when they were sick.

"The Messenger of Allah (ﷺ) entered upon us, and with him was Ali bin Abu Talib, who had recently recovered from an illness. We had bunches of unripe dates hanging up, and the Prophet (saw) was eating from them. Ali reached out to eat some, and the Prophet (saws) said to Ali: 'Stop, O Ali! You have just recovered from an illness.' I made some greens and barley for the Prophet (ﷺ), and the Prophet (ﷺ) said to Ali: 'O Ali, eat some of this, for it is better for you.' [Sunan Ibn Majah, The Chapters on Medicine, Hadith No: 3442]

So, there is no problem if Physicians ask their patients to cut down dates intake in Ramadan to limit the calories. The sunnah can be achieved by taking a single date or even a small part of it. Diabetics can choose dates that are lower in sugar content like the Ajwa or the Deglet Nour or the Barhi (semi-dry). 

If it is proven that a patient will more likely get harmed due to eating dates, it is perfectly fine from a shariah perspective to advice him against taking it. 

But any such advice should be done based on a proper scientific analysis by taking the following thinks into consideration:

-The glycemic index (GI) of dates varies according to the variety of dates and the stage of their ripening. 

-Generally people do not eat only dates at Iftar. The effect on blood glucose will vary if other foods are taken with dates. Proteins, fats and fiber intake will all alter and decrease the glycemic effect.

-Brisk walk after Iftar to the masjid for Maghrib Salah will also decrease the blood glucose spike. That's what most people do.

-Also the extent of diabetes control of the person will affect his body response to dates intake.

Any good study has to take all these things into consideration before giving any blanket recommendations.

Moreover there are many studies which actually say that dates may not be that harmful for diabetics after all.

For example:

'Effect of dates on blood glucose and other metabolic variables: A narrative review'

by Sachdev Meenakshi and Anoop Misra says:

"The glycemic index (GI) of date varieties ranges from 42.8 to 74.6, and glycemic load (GL) 8.5–24. 

The glycemic indices of various stages of dates are; Rutab (semi-ripe), 47.2; Tamer (fully ripe, traditionally sun-dried), 45.3, and Tamer (commercial), 35.5. 

Glucose tolerance-based studies and cross-sectional studies show no significant changes in glycemic indices or association with glycemic worsening with intake of dates. Few randomized controlled trials (RCT) also showed no change in glycemia and weight in the intervention groups consuming dates."

Glycemic indices of five varieties of dates in healthy and diabetic subjects

By Juma M Alkaabi (Nutr J. 2011 May 28;10:59. doi: 10.1186/1475-2891-10-59)
“The results show low glycemic indices for the five types of dates included in the study and that their consumption by diabetic individuals does not result in significant postprandial glucose excursions.”

‘Glycemic indices of dates “Ramadan Symbolic Food” in patients with type 2 diabetes using continuous glucose monitoring system’

By Samir Assaad Khalil (Diabetes Research and Clinical Practice, Volume 172, February 2021)

Can People with Diabetes Eat Dates?
by Lisa Wartenberg, MFA, RD, LD  (https://www.healthline.com/nutrition/dates-for-diabetes)
“If you have diabetes, consider eating dates alongside a source of protein, such as a handful of nuts, which supports your body digesting the carbs a bit more slowly, further helping prevent blood sugar spikes.”

“dates generally have a low GI, between 44 and 53, which may differ slightly depending on the type of date”
 “they have a low GI and medium GL, those living with diabetes can enjoy dates in moderation.”. 

There are many other such studies and articles from different countries. What is needed is more RCTs (randomized controlled trials) pertaining to the glycemic index of different date varieties in different amounts and in combination with different traditionally taken Iftar meals in our homes and different levels of patient physical activity post Iftar. This will enable the Physicians to give proper evidence based and personalised advise to each patient.

Meanwhile it's ok to caution the patients to limit calorie intake through dates and other fruits in a nuanced way to avoid both dates-overindulgence and dates-phobia.

Fiqh of Organ Donation and Transplantation

Organ Donation and Transplantation

-Dr. Md. Habeeb Haris

The magnitude of the 'transplantation problem' and the organ demand - Indian scenario:

As of March 2024, India had over 300,000 patients on the waiting list for organ transplants, with at least 20 people dying each day while waiting. This is due to a shortage of organ donors, especially deceased donors, which has not kept up with increasing demand. The demand for deceased donors is substantial because many families lack suitable living donors.

In 2022, India performed over 13,300 living transplants and about 2,700 deceased donor transplants, but the number of donors only grew from 6,916 in 2014 to about 16,041 in 2022. India's organ donation rate is also low, at 0.52 per million people.

In India, living donors comprise 85% of all donors. Around 70%-75% of donors are female. Wives, mothers, and sisters have emerged as most prevalent sources of donation.

[The above figures were taken from https://www.thehindu.com/sci-tech/health/indias-poor-organ-donation-record-continues-to-cost-lives/article67161978.ece]

These figures show us how many lives are affected by this issue and why is it important for us to address the Fiqh aspects of it.

The Quran and Sunnah do not directly mention about organ transplantation. So, related Shariah topics such as ownership of the body, human dignity, prohibition of mutilation, necessity of treatment to save lives, and various Qawaid (Maxims) of Fiqh such as choosing the lesser harm to avoid greater harm, etc., are used by the Ulama to arrive at a ruling through Ijtihad. This is the reason for multiplicity of views on this and many other recent medical issues.

Types of Transplantation of organs

Transplantation of animal organs (Xenograft)

Transplantation of an organ from one place of the body into another place of the same person (Autograft)

Transplantation of organs of a living donor into recipient (Allograft)

Transplantation of the organs from a dead human donor

Transplantation of animal tissues/organs (Xenograft)

1. From Halal and Islamically slaughtered animals (goat, etc.) 
 It is permissible to use organs of such animals for transplantation or other medicinal purposes. 
 ‘There is no harm in treatment with bone if it is the bone of a goat or cow or camel or horse or any other such animal except the bone of swine.’ (Al-Fatawa Al-Hindiyyah: 5/354)

2. From Haram animals and swine 
Transplantation of their organs is not allowed normally. It's allowed only with the following conditions:

- The organ is necessarily for treatment.

- There is no halal substitute available.

- It has been prescribed by a God-fearing Muslim doctor. 

Transplantation of an organ from one place of the body into another place of the same person (Autograft)

Generally the classical jurists of all the four major schools of Fiqh (Fuqaha) have allowed it for treatment purposes when there is a medical need. (Imam Abu Yusuf’s opinion in Hanafi fiqh (see Badai us-Sanai: 5/133), Imam Ahmad (Al-Jame’ li ulum al Imam Ahmad: Hadith: 30711) and Imam Shafi (as explained by Imam Nawawi in Al-Majmou: 3/139) 

The International Islamic Fiqh Academy (IIFA) of the Organisation of Islamic Countries (OIC), Jeddah resolved, “An organ may be transplanted from one part of the body to another part of the same body, provided it is ascertained that the benefits accruing from this operation outweigh the harmful effects caused thereby; also provided that its purpose is to replace a lost organ, reshape it, restore its function, correct a defect or remove a malformation which is a source of mental anguish or physical pain.” [IIFA Resolution No. 26 (1/4)]

The Fiqh Academy of the Muslim World League (MWL), Makkah resolved, “Taking a part of the human body--a piece of skin or bone and transplanting it into another place of the body of the same person in case of necessity is allowed”. ('Makkah Fiqh Academy': 200-201)

Islamic Fiqh Academy, India also passed a similar resolution. (see 'Naye Masail aur Fiqh Academy ke faisle': 215)

Conditions for Autograft permissibility:

• The part was not amputated as a punishment in judicial amputation (Hadd or Qisas). 
• It is medically necessary and there is no other alternative. It is not allowed just for beautification purposes.
• Harm of this surgery is less than the harm caused if it is not done. 
• There is a high probability for this surgery to be successful. 
  

Transplantation from a Living Human Donor

Allowed if the organ is:
-Self-regenerating, such as blood and skin.
-From part of an organ that was removed due to a medical deficiency, such as the cornea of the eye that had to be removed due to another disease.
-Is not single; and removing it doesn't cause significant loss of function or risk of death, like kidneys, then donation of these organs is allowed to save the life of another human being.

Forbidden if it is:
- a vital organ, such as the heart, without which the donor cannot remain alive.
- an organ such as the cornea of the eyes, donating which deprives the donor of a primary function of his body. 
-Transplantation of genitals and gonads is not allowed.
[Al Qadhaya al Tibbiya al Muasarah: 490 and IIFA Resolution No. 26 (1/4)]

General conditions:
-Allowed only when no alternative is available.
-It should not be done for financial reasons (selling an organ), because under no circumstances should a person’s organ be sold.
-Proper consent should be taken, which should be fully voluntary and without any pressure (social, emotional, financial, family pressure, etc.).

-After transplantation of an organ, there should be no apparent unsightly changes in the body that resemble mutilation.
-There should be a good chance that the person to whom an organ is given will be benefited by the transplantation.

Mufti Taqi Usmani adds: 
Every effort should be made to find an organ donor who is a Muslim for a Muslim recipient and a Muslim's organ should not be given to a non-Muslim. (Fatawa Usmani: 4/225)
However, other scholars say that this is not an absolute condition but only desirable.

Transplantation from a Dead Human Donor

There is a difference of opinion on this too. The majority of the scholars and Fiqh bodies globally are in favour of it's permissibility.

The International Islamic Fiqh Academy (IIFA) says, "It is allowed to transplant an organ from the body of a dead person, if it is essential to keep the beneficiary alive, or if it restores a primary function of his body, provided it has been authorised by the deceased before his death or by his heirs after his death or with the permission of concerned authorities if the deceased has not been identified or has no heirs. [IIFA Resolution No. 26 (1/4)]

The Islamic Fiqh Academy, India is against it. It resolved, “If someone expressed his wish that after his death his organs may be used for transplantation purpose it cannot be considered as Wasiyat (will) according to Shariah and is invalid according to Shariah and such a wish is not to be honored.” (Islamic Fiqh Academy, India - Fiqhi Seminar in New Delhi 1-3 April 1989)

                                           Range of fatawa on transplantation of human organs

Arguments of those who Oppose human organ transplantation

-Human Dignity and Sanctity: Human body, whether living or dead, should be honoured. The Quran says,
 “We have honoured the sons of Adam and conveyed them on land and sea and provided them with good things and favoured them greatly over many We have created.” (Surah Bani Israil, 17:70) 
 The prophet Muhammad ﷺ rebuked a man who broke a bone of a corpse that he found in a cemetery. The prophet said, “Breaking the bones of a dead man is like breaking the bones of a living man (in sin).” (Abu Dawud: 3207)

-Commodification: Most of the classical Fuqaha have forbidden utilising parts of the human body so that man should not become a commodity. This is against his dignity. (for example, Al Bahr al Raiq 6/81)

-Ownership: Human being is not the owner of his body. Charity requires ownership of the things which one wants to donate, or he should be permitted to do so from the real owner. Our body is an Amanah of Allah so its organs cannot be donated or sold. 

-Prohibition of Mutilation: Separating a part of a human being from his body, which brings no bodily benefit to him, is considered as an act of mutilation.


Arguments of those who Permit human organ transplantation

-Necessity: Harvesting the organs from living or dead human donors for transplantation is allowed due to medical necessity as according to the Shariah, even the prohibited things become permissible for saving life or a critical function of a person.
The Quran says,
“But whoever is forced (by necessity), neither desiring (it) nor transgressing (its limit), there is no sin upon him.” (Surah Baqarah, 2:173)  

The Scholars also cite the famous principles of Fiqh in this - ‘Necessities permit prohibited things’. (Al-Ashbah: 8/84) and 'Difficulty requires ease'. (Ibid.)

Al Binaya, the commentary on the famous Hanafi fiqh text 'Al Hidayah' states, "Drinking blood, urine and eating dead meat for medication and treatment is allowed if a Muslim physician states that his cure lies in it and he finds no lawful medicine which can substitute it." (Al-Binaya: 12/271)

-Organ harvesting is not mutilation or dishonouring: Surgical procedures for organ harvesting do not come under mutilation of human body as there is no disfigurement or disrespect involved in it. It is a professionally performed surgical procedure.
Moreover, it is known from various fiqh examples that even disrespect of honourable things is permitted for saving a life if needed. (Vide Khulasatul Fatawa: 4/361)

-Human dignity: If someone donates a part of his body to others, neither does he feel dishonoured nor do the other people feel so; rather he is more respected in the society. That is why prominent leaders and celebrities of the society bequeath to donate their body parts and this is considered as a virtuous, altruistic and humane act. 

-Sale of human organs is prohibited: Even those scholars who permit transplantation do not allow sale of organs so there is no question of reducing the human body to a commodity.

-Benefit to humanity: Transplantation is a source of removing pain and suffering from human beings and has individual, collective and social benefits. It is a great example of sympathy and sacrifice.

-Ownership and Utilisation of human parts: Blood donation and transfusion from other human beings has been almost agreed upon as permissible in Shariah. If absolute utilisation of any part of the body is regarded to be an act of dishonour or crossing the limits of ownership, it should be unlawful too, as blood is also a part of the body. Moreover, we do not absolutely own our wealth too. It is also an Amanah of Allah but giving it to others is not considered as infringing upon the ownership of Allah. 

The early Fuqaha prohibited utilisation of human organs because in their time, utilisation of human organs was considered to be an act of insult, desecration and objectification. Such methods were also not invented in that age so that organs of the human body could be utilised gently and gracefully. (These arguments have been summarised from 'Jadeed Tibbi Masail' of Mufti Abubakar Qasmi)

Philosophy of Medicine - Islamic vs. Western

Philosophy of Medicine - Islamic vs. Western

-Dr. Md. Habeeb Haris

Islamic and Western philosophies approach medical practice with distinct perspectives shaped by their broader worldviews, though there are some overlaps.

 1. Theological Foundation vs. Secular Foundation:

   - Islamic Philosophy: Islamic philosophy of Medicine is deeply rooted in the Islamic Epistemology. It's values are based on the Qur'an and Sunnah. The approach is theocentric, meaning it places God at the center of all considerations. Medical practice is seen as a form of worship, a part of fulfilling God's will, and serving humanity, with a strong emphasis on the sanctity of life, the spiritual role and moral responsibility of the physician, and the importance of intentions (niyyah).

   - Western Philosophy: Western medical practice often stems from a secular, humanistic foundation and is influenced by ancient Greek, Roman, and Enlightenment philosophies. Philosophical approaches in the West may vary widely, from utilitarianism to deontological ethics, often focusing more on individual rights and social contracts. 

 2. Holistic vs. Analytical Approach:

   - Islamic Philosophy: Islamic medicine tends to take a holistic approach, considering not only the physical aspects of a person but also the spiritual, psychological, and social dimensions. The mind, soul (ruh) and body are interconnected, and medical treatment often involves addressing all these aspects. Prayers, supplications, family and community support, and trust in God play a role.

   - Western Philosophy: Western medical practice is typically more analytical and reductionist, often focusing on the physical body and biological mechanisms. Cartesian duality which has significantly influenced the Western medicine envisions the mind and body separately. (Rene Descartes, a prominent philosopher, proposed the concept of mind-body dualism.) However, in recent years, there has been a growing interest in holistic approaches, but these are often seen as complementary or alternative to mainstream medicine.

 3. Ethical Decision-Making:

   - Islamic Philosophy: Ethical decisions in Islamic medical practice are guided by the objective morality of the Sharia (Islamic law), which derives from religious texts. Scholars may issue fatawa (legal opinions) to address new medical issues, ensuring that practices align with Islamic values.

   - Western Philosophy: In Western medical ethics, decision-making is based on a subjective morality primarily guided by secular ethics. Less influenced by religious or cultural norms. It often involves balancing the four main ethical principles—autonomy, beneficence, non-maleficence, and justice. Patient autonomy is particularly emphasized, with individuals having the right to make informed decisions about their own care, even if these decisions conflict with medical advice.

 4. Preventive vs. Curative approach:

   - Islamic Philosophy: There is a strong emphasis on disease prevention. Many Islamic teachings inherently have a benefit of disease prevention. Encourages the use of natural treatments alongside conventional medicine.

   - Western Philosophy: Often prioritizes treatment and intervention over prevention.

 5. Community vs. Individual Focus:

   - Islamic Philosophy: Learning and practicing medical science is a collective obligation (Fardh e Kifayah) on the community as a whole and the physicians are honoured for discharging this religious obligation on behalf of the entire community. There is a strong emphasis on community welfare in Islamic medical practice. The health of the community is often considered alongside individual needs, and public health measures are encouraged as a collective responsibility. Islamic teachings promote the idea of mutual care and responsibility among believers. 

   - Western Philosophy: While public health is an important aspect of Western medical practice, the emphasis is often on individual rights and choices. Medical decisions are typically seen as the domain of the individual, with less emphasis on the community’s role in personal health decisions.

 6. Understanding of Health and Disease, Life and Death:

 - Islamic Philosophy: Health and life are considered as a trust and gift of God to be preserved and protected as well as a means of test, to be utilised properly for achieving eternal success in the Hereafter. Disease, pain and suffering are considered as a part of Destiny and a test from God to be shown patience for, even as prevention and treatment are sought. Sickness is also considered as a means of spiritual growth, forgiveness of sins and increasing one’s rewards and ranks with God.

Seeking treatment is considered as  religiously encouraged (Sunnah) and, some times, even obligatory. Death is not considered as an end. Rather it is seen as a gateway to an eternal life and a means of meeting with God Almighty. However it is not to be sought or desired and generally all possible effort is to be made to preserve life.

   - Western Philosophy: Sees them only through a biological lens and disease is seen mostly in a negative light.

 7. Role of the Physician:

   - Islamic Philosophy: The physician in Islamic thought is seen as a Khalifa (Agent) of God in healing the sick on His behalf and as a steward of God's creation. They are not only responsible for the physical health of their patients but also their mental and spiritual well-being. The physician is expected to act with Ihsan (excellence) and Taqwa (God-consciousness), viewing their work as a form of worship.

   - Western Philosophy: In Western practice, the physician's role is primarily of a professional providing medical care based on scientific knowledge. The spiritual dimension is ignored.

In summary, the Islamic and Western philosophies differ significantly in their foundational principles, approach to ethics, and the role of spirituality in medical practice.

Towards a Shariah Compliant and Ibadah Friendly Hospital

 Shariah Compliant and Ibadah Friendly Hospital

(Adapted from Journal of the British Islamic Medical Association - Vol. 7 - May 2021)

What is involved in establishing a Shariah Compliant and Ibadah Friendly Hospital? Is it important for us to know what it is all about? Do we need to establish this program in our hospitals?

It may not sound important to many of us, especially if we think we are successful in our career. The majority of Muslim Doctors do not pay much attention to this issue of Islamisation of their medical practice and hospital/clinic.

Points to ponder:
1. How many of our Muslim patients perform their salat while they are under our care?
2. Who is responsible for helping Muslim patients perform their salat in our hospitals?
3. ⁠Do our hospital staff guide the patients regarding how to modify Ghusl, Wudhu, Salah, Fasting, etc., due to their illness according to Fiqh?
4. Have we ever discussed Islam or spirituality with our patients?
5. Have we or our staff ever assisted terminally ill patients under our care in the final seconds of their life to die with Husn al Khatima by reciting the Shahada?
6. ⁠Do we follow Gender and Satr / Haya rules in our hospitals?
7. ⁠Do we follow the Shariah limits and guidelines in doing the various procedures like IVF, Abortion, Plastic Surgery, etc.?

To answer the first question, it is known that most of the patients in the hospitals do not perform their salat. Can we imagine if it happened to ourselves or to our families?

Below are some of the reasons why they do not perform their prayers:
1. Patients assume they can replace their prayers later(qadha)
2. They assume they are being excused from praying because of their illness and being in the hospital
3. Patients are ignorant about the Fiqh issues
4. No assistance and guidance from medical staff
5. Hospital management do not provide support and facilitate patients to perform their ibadah
6. The assumption that the Muslim patients should understand and know their responsibility.

Have we ever thought about who is going to help us to say Shahadah or remind us to remember Allah at the end of our life? How would we feel if our relatives died after resuscitation without being assisted to say the Shahadah? Are those duties expected from the Muslim staff? Are we aware that the ultimate goal of a Muslim is to die with Husn al Khatimah?

Standards In Shariah Compliant and Ibadah Friendly Hospital (IFH):

The following discussion will focus on the proposed Standards In IFH. These standards should be taken into consideration when planning the implementation of this program.

1. HOSPITAL POLICY OF IMPLEMENTING IFH:
 
Adopting the IFH as a hospital policy
Integration and assimilation of good values in hospital administration
Vision and Mission of Hospital taking into consideration the IFH program toward excellent hospital services
Stakeholders should ensure that the IFH becomes an integral part of the hospital policy.

2. ORGANISATION STRUCTURE:

Establishment of an IFH Committee with specific job scope and organizational chart that reflects this aspiration.
Direct involvement of the Hospital Director and senior members of the management in the IFH Committee
Establishment of Spiritual Department or Shariah Department in ensuring the successful implementation of IFH programs
Regular meeting and report by the committee (at least 4x/year)

3. CULTURE IN IFH:

GENERAL CULTURE
-good values – (Itqan/Ikhlas/Ihsan)

SPECIFIC CULTURES
-Culture of smiling &salam
Reciting Bismillah/Alhamdulillah/Insha’Allah at appropriate time pre/during or post procedure
Remembering God
Campaign/poster/banner promoting these cultures and awareness of IFH
Continuous monitoring of the staff practices and assimilation of these practices

4. HUMAN RESOURCE MANAGEMENT:

Basic training – awareness about IFH
Introduction programs and basic trainings for all staff on IFH
Preparation of manual for basic training in IFH
REGULAR ongoing program – sustainability and monitoring

5. FACILITIES FOR IFH:

Orientation for patients about salat facilities and providing assistance to those needed
Salat reminder/assisting patients to perform salat
Audio visual facilities in reminding patients/staff on prayer
Facilities to perform salat (Qibla direction/proper attire/clean area)
Bottle spray/Tayammum powder/Books/Guidelines for prayer/wudhu/Tayammum)
Patients attire – covering Awrah in ward/during delivery/ procedure & surgery
Separate wards/rooms for different gender

6. SOPS IN IFH:

General SOPs – assimilation of good values at all levels-good character (akhlaq)
SOPs in all clinical settings – orientation for new admission
Pre & post procedures
Chaperone
Guiding and helping patients to perform ibadah

7. DIGNITY OF PATIENTS AND STAFF:

ECG, USG and other procedures by same gender
Catheter performed by same gender
Ensuring awrah/Satr of patients in OT/delivery rooms are being taken care of following shariah guidelines

8. HUSNUL KHATIMAH:

Establishing chaplaincy services – (talqin services/spiritual support for patients and relatives)
Assisting family in preparing WASIAT/Family support
Talqin – encouraging family to talqin patients/ensuring staff available to support patient during terminal stage
Assisting family for the funeral arrangement

9. QUALITY MANAGEMENT:

Quality Committee in monitoring the implementation of IFH
Internal and external audit
Patient’s feedback regarding the IFH programs in the hospital
Scheduled monitoring of the programs

These are some of the suggested elements which could become the essentials in the implementation of IFH.There are many additional programs which need to be implemented in IFH. All departments and sections need to prepare SOPs and programs related to the IFH.

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”. 


                                 

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)

Fiqh of Using Medicines containing Gelatine

Use of Gelatine in Medicine
Dr. Mohd Habeeb Haris MD

Gelatine is a protein obtained by partial hydrolysis of animal tissues such as skin, tendon, ligament, bone, cartilage and hooves. The product seems to be of a variety and from the technical standpoint, the raw material must be selected according to the purpose intended. Raw materials intended for medicinal use as well as food production are generally skin and bone of cattle, sheep and pigs. 80% of gelatine in Europe is of porcine origin.

Gelatine is used in the preparation of many pastes, and is the main ingredient in all hard and soft capsules. Gelatine capsules are used as a means to deliver drugs mainly via oral route. Gelatine is also used as a binding agent in some tablets and lozenges.

It is also used in many food products such as ice-cream, jellies, chocolates, sweets, jams, pastries and jellied meats. It acts as a stabilising and smoothing agent in foods. (Muslim Food Guide, 97/98 Edition)

Does gelatine go through istiḥala (complete substance transformation)?

Fatwa of Darul Uloom, Karachi:

Maulana Sarfaraz Muhammad, who wrote this fatwa [which is printed in his book ‘Halal Ghiza Jadid Tibb aur Science’ (pages 37 to 52)], presents a detailed discussion on the definition and standard of istihala, and then goes on to determine that gelatine does go through some chemical change but does not go through a complete change of essence. Rather, the essence is exactly the same and has just been broken down much more. He explains the process is more similar to that of cooking the meat rather than any actual structural change. Many scientific references are quoted to support his statement. Below are a few out of the many quoted:

“Conversion of collagen to gelatine occurs during normal cooking of meat, and this accounts for the gelatinous material that is sometimes evident in meat after heating and cooling….” (Food Chemistry pg. 906, Owen R Fennema)

“The transition of collagen to gelatine outlined above occurs during the cooking and roasting of meat.” (Food Chemistry pg. 546, H.D Blitz, Werner Grosch, Peter Schieberle)

He concludes by saying that since porcine gelatine does not go through a complete change of essence, rather, the essence is exactly the same and has just been broken down into smaller fragments, its use is impermissible. (Darul Ifta of Darul Uloom, Karachi, Fatwa No.: 2/1276; Checked by Mufti Taqi Usmani)

Ruling of International Islamic Fiqh Academy, Jeddah:
Question: What is the ruling on using porcine gelatin transformed into other components in foods, in such a way that it renders laboratory identification impossible?

Answer: “It is not permissible to use pig-derived gelatin in foods through the method mentioned above, but it is permissible to use it in medicines if there is no other alternative.” (Resolution No. 225 (9/23), https://iifa-aifi.org/en/6233.html )

Mufti Muhammad bin Adam of Darul Iftaa, Leicester, UK, says:
“If gelatine is derived from pork or an unlawful animal or an animal not Islamically slaughtered, then it is impure and haram. However, if it is derived from a halal source, then there is permissibility in its usage. Most contemporary scholars declare gelatin as unlawful (haram) due to the fact that firstly it is difficult to establish where it’s derived from, and secondly it is mainly derived from pig or haram animal and the change it undergoes is not sufficient for it to be classed as halal. The Islamic Fiqh Academy, Jeddah, Resolution number 23 [1986], considers it as being non-halal.
The ‘chemical change’ that takes place during the manufacture of gelatine is not sufficient to be considered a full transformation (istihala/tabdil al-mahiyya), such as when alcohol transforms into vinegar or when a pig falls into a salt mine and fully turns into salt. Scientifically when meat is cooked, it undergoes structural and chemical change, but remains meat. As such, when pig meat is cooked, it still remains pork and is haram.” (https://daruliftaa.com/food-drink/medicines-with-gelatine/)

However, the Islamic Fiqh Academy, India has a somewhat different view on the issue of gelatine. It decided in the 14th Fiqh Seminar (Hyderabad – A.P) 20-22 June 2004:

“Gelatine is an organic substance, which is a type of protein. It is formed when another protein the Collagen found in the skin and bones of animals undergoes chemical transformation. The substance so obtained takes the form of a different protein, the chemical and medicinal properties of which are absolutely different from that of the Collagen. It is also dissimilar to the Collagen in terms of its colour, smell, taste and other characteristics. In case the substances, which are described as impermissible by Shariah, undergo a complete process of metamorphosis, then the validity of the law does not hold well. The special or basic properties of the substance, by which it has been universally accepted and identified, are the real characteristics and identification of the substance. According to the research undertaken by the scientific experts, Gelatine does not possess the characteristics and properties of the skin and bones of animals, whose Collagen is used to prepare Gelatine. In fact, an altogether new substance is produced which has distinctly different characteristics from its parent substance. Therefore, there is a room for its use.

In view of differences between the jurists as well as the importance of edible substance, the Seminar earnestly appeals to the Muslim businessmen and traders to prepare Gelatine only from permissible animals using the permissible and clean parts of their body, so that there may be no dubiety over the issue of its permissibility and lawfulness.”
(http://www.ifa-india.org/pdfs/pdf-20210602034956.pdf)

Conclusion: Most fuqaha in our times consider gelatine to be an impure substance (if derived from pork or an animal not Islamically slaughtered), holding that the change it undergoes from its original state is not sufficient to be considered essential transformation.

Therefore, most of the scholars have declared gelatine as unlawful (haram) due to the fact that firstly, it is difficult to establish where it’s derived from, and secondly, the change it undergoes is not sufficient for it to be classed lawful (halal).

However, the Hanafi jurists (fuqaha) have given a dispensation in using impure and unlawful substances for medical purposes, provided certain conditions are met.

The classical Hanafi jurist, Imam al-Haskafi (Allah have Mercy on him) says:

“The Scholars differed regarding the usage of haram medication. The apparent opinion in the (Hanafi) school is that it is haram. However it is said that, it will be permissible when the medicine is known to be effective and there is no other alternative, just as there is a dispensation in drinking alcohol for a person dying of thirst, and the fatwa is given on this opinion.” (Durr al-Mukhtar, 1/210)

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

In view of the above text from one of the fundamental Hanafi reference books, 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/)