Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan
Background: For an effective treatment of patients, quality-assured safe implementation of drug therapy is indispensable. Fasting during Ramadan, an essential religious practice for Muslims, affects Muslim diabetics’ drug use in a number of different ways. Objectives: Ethical problems arising from fasting during the month of Ramadan for practicing Muslim patients are being discussed on the basis of extant research literature. Relevant conflicts of interest originating in this situation are being analysed from an ethical perspective. Material and methods: A number of databases have been searched systematically in view of the stated objectives to identify relevant studies. Starting point for this review are the following questions: What information is available regarding the fasting behaviour of Muslim diabetics during Ramadan? What kind of ethical problems can be identified in the context of this religious practice? Results: The present review established a number of problems concerning medication adherence and drug use of practising Muslim diabetics during Ramadan, notably insufficient compliance, reduced frequency of consultations with their doctor, and inadequate, not sufficiently goal-oriented doctor-patient conversations about fasting. Conclusions: Deficiencies in medical as well as religious knowledge about fasting in Ramadan and a lack of sensitivity have been found among Muslim patients as well as among doctors. Compliance management and drug use in this area can be improved by effective, goal-oriented action plans and projects through which linguistic and cultural barriers can be addressed.
KeywordsMedication adherence Compliance Fasting Patient autonomy Muslim patients with diabetes Intercultural physician–patient relationship
- Al-Ghazali, Abu Hamid. 1992. The Mysteries of Fasting, Ihya’ ‘ulum al-din, Trans. Nabih Amin Faris, Lahore: Sh. Muhammad Ashraf.Google Scholar
- Atasoyu, Enes Murat. 2015. In which chronic diseases can fasting threaten health? https://www.anadolusaglik.org/blog/oruc-hangi-kronik-hastaliklarda-sagligi-tehdit-edebilir Accessed 7 April 2017.
- At-Tirmidhi, Muhammad lbn ‘Eisa. 2007. Jami’ at-Tirmidhi 6. Trans. Abu Khaliyl. Riyadh: Maktaba Dar-us-Salam.Google Scholar
- Beauchamp, Tom Lamar, James Franklin Childress. 2013. Principles of biomedical ethics (7th edn). Oxford, New York: Oxford University Press.Google Scholar
- Das Wissensportal zum Thema Kultur und Gesundheit. 2017. http://www.kultur-gesundheit.de. Accessed 1 Jan 2017.
- Dönmez, İbrahim Kafi. 2007. Oruç. In İslam Ansiklopedisi, ed. Diyanet İşleri Başkanlığı, 33: 416–425. Istanbul: Türkiye Diyanet Vakfı Yayınları.Google Scholar
- Ess, Joseph van. 1980. Islam. In Die fünf großen Weltreligionen, ed. E. Brunner-Traut, Freiburg: Verlag Herder.Google Scholar
- Hökelekli, Hayati. 2000. İntihar. In İslam Ansiklopedisi, ed. Diyanet İşleri Başkanlığı, 22: 351–353. Istanbul: Türkiye Diyanet Vakfı.Google Scholar
- Ibn Arabi, Muhyiddin. 2000. The Secrets of the Fast VII. In Futuhat 9, Chap. 71, p. 378–389.Google Scholar
- Ilkilic, Ilhan. 2002a. Bioethical conflicts between Muslim patients and German physicians and the principles of biomedical ethics. Medicine and Law 21(2): 243–256.Google Scholar
- Ilkilic, Ilhan. 2002b. Der muslimische Patient. Medizinethische Aspekte des muslimischen Krankheitsverständnisses in einer wertpluralen Gesellschaft. Diss. Münster: Lit.Google Scholar
- Ilkilic, Ilhan. 2014. Interculturality and ethics in health care. In Health, culture and the human body: Perspectives from Turkey and Central Europe, ed. Ilhan Ilkilic, Hakan Ertin, Rainer Brömer, Hajo Zeeb, 697–709. Istanbul: Betim Center Press.Google Scholar
- Islam Question and Answer. 2017. http://islamqa.info/en/1319. Accessed 1 Jan 2017.
- Karagöz, İsmail, Halil Altuntaş. 2010. Oruç İlmihali. Ankara: Diyanet İşleri Başkanlığı.Google Scholar
- Mardhiyah, Radhiyatam, Makmun, Dadang, Syam, Ari F., et al. 2016. The effects of Ramadhan fasting on clinical symptoms in patients with gastroesophageal reflux disease. Acta Medica Indonesia 48(3): 169–174.Google Scholar
- Memorial Hastanesi İç Hastalıkları. 2009. Is fasting of chronic patients inconvenient? https://www.memorial.com.tr/saglik-rehberleri/kronik-hastalarin-oruc-tutmasi-sakincali-mi/ [Turkish] Accessed 7 April 2017.
- Muslim, Ibn al-Hajjaj Imam Abul Hussain. 2007. Sahih Muslim 1–3. Trans. Nasiruddin al-Khattab. Riyadh: Maktaba Dar-us-Salam.Google Scholar
- Nugraha, Boya, Ghashang, Samaneh K., Hamdan, Imad, et al. 2016. Effect of Ramadan fasting on fatigue, mood, sleepiness, and health-related quality of life of healthy young men in summer time in Germany: A prospective controlled study. Appetite 111: 38–45. doi:10.1016/j.appet.2016.12.030.CrossRefGoogle Scholar
- Pew Research Center. 2017. http://www.pewresearch.org/fact-tank/2015/01/15/5-facts-about-the-muslim-population-in-europe/. Accessed 1 Jan 2017.
- Rosenthal, Franz. 1990. On suicide in Islam. In Muslim intellectual and social history: A collection of essays, 239–259. Hampshire: Variorum.Google Scholar
- Salti, Ibrahim, Benard, Eric, Detournay, Bruno, et al. 2004. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: Results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care 27: 2306–2311.CrossRefGoogle Scholar
- Sass, Hans-Martin. 1989. Einführung. In Medizin und Ethik, ed. H.-M. Sass, 5–16. Stuttgart: Reclam.Google Scholar