What is the ruling regarding a person who was advised by their doctor to refrain from fasting? A man with a heart condition underwent a cardiac catheterization procedure and was advised by his doctor not to fast during Ramadan. Is it permissible to go against the doctor’s instructions and fast? Would fasting incur sin?

It is well established in Islamic law that it seeks to facilitate matters and remove hardship. It prohibits anything that would cause undue difficulty or expose a Muslim to harm or danger. This is based on the general implication of the verses, “Allah intends for you ease, and does not intend for you hardship” (Quran, 2:185), “Allah does not intend to place upon you any hardship, but He intends to purify you and complete His favor upon you that you may be grateful” (Quran, 5:6), and “He has not placed upon you in the religion any hardship” (Quran, 22:78).

Islamic law has also made legal obligations contingent on capability; Allah the Exalted says, “Allah does not burden a soul beyond its capacity” (Quran, 2:286). Abu Huraira (may Allah be pleased with him) narrated that the Prophet (peace and blessings be upon him and his family) said, “If I command you to do something, then perform as much of it as you are able” (recorded by Bukhari and Muslim). For this reason, Allah Almighty followed the command of fasting with facilitation for those who experience undue hardship as a result of illness or travel, saying, “So whoever among you is ill or on a journey—then an equal number of days [are to be made up]” (Quran, 2:184).

Fasting under medical prohibition and its consequences

If an ill person faces the risk of harm, danger, or death in addition to hardship, and this is affirmed by a trustworthy, specialized physician, the majority of jurists hold that refraining from fasting becomes obligatory. This falls within the general scope of the legal evidences on preserving life and avoiding anything that may endanger or harm it; Allah Almighty says, “And do not throw yourselves into destruction” (Quran, 2: 195) and “And do not kill yourselves. Indeed, Allah is ever Merciful to you” (Quran, 4:29). One of the maxims of Islamic law is: “Harm must be removed.”

 

Scholarly opinions

The Hanafi jurist, al-Kasani, noted in Bada`i’ al-Sana`i’ (2:94), “When fasting exposes a person to the risk of death, refraining from fasting is not just permissible, but obligatory. This is because carrying out the obligation would put one at risk of self-destruction, rather than fulfill Allah’s rights. In such a case, the original obligation no longer applies and becomes prohibited. Therefore, refraining from fasting is not only permissible—it is obligatory.”

Likewise, Ibn Juwzayy al-Ghirnati, the Maliki jurist, mentioned in Al-Qawanin al-Fiqhiyyah (pp. 219-221), “An ill person is unable to fast, risks death due to their health condition if they do, or suffers debility as a result of fasting. So, refraining from fasting becomes obligatory.”

The Shafi‘i scholar, Shams al-Din al-Khatib al-Shirbini, wrote in Mughni al-Mutaj (2:169), “It is obligatory to refrain from fasting if one fears the risk of death, as al-Ghazali and others explicitly stated, and as al-Adhra’i confirmed.”

The Hanbali scholar, ‘Alaa` al-Din al-Mardawi, likewise maintained in Al-Insaf (3:285), “An ill person who fears that fasting may exacerbate or prolong their illness, or a healthy person who later becomes ill or fears falling ill due to thirst or other reasons, is recommended to refrain from fasting. Scholars agree that for such a person, it is disliked to fast or to continue a fast.”

 

The ruling

An ill person who is advised by a trustworthy, specialized physician not to fast in Ramadan due to the risk of death or serious complications should refrain from fasting. Fasting despite this advice makes the person blameworthy and sinful, as it goes against medical guidance and exposes them to harm, which Islamic law prohibits. They should make up the missed fast days once their health has fully recovered and stabilized, in accordance with the words of Allah, “Then an equal number of days [are to be made up].” If the illness is chronic, they are required to pay fidya, which consists of feeding a poor person for each missed fast day. If they cannot afford this, then nothing is required of them.

And Allah Almighty knows best.