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Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan

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Abstract

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.

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Notes

  1. “Every action of the son of Adam belongs to him except the fast. It is Mine, and I repay him for it.” (Muslim 2007, Vol. 3, p. 163).

  2. Islamic scholars have different opinions about the question if an insulin injection invalidates the fast. Some argue that giving insulin for therapeutic reasons is compatible with fasting, while others oppose and suggest that Muslim patients in need of insulin treatment should forgo the fast. The use of oral antidiabetics during the fast, on the other hand, is generally being rejected.

  3. A good example for such information sources is the knowledge portal ‘Kultur und Gesundheit’ (culture and health) in German. This portal enables professional healthcare givers short information about religious practices of Muslim patients, including fasting during Ramadan. http://www.kultur-gesundheit.de.

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Acknowledgements

This article was initiated by the project ‘Drug Use Issues in Patients with Migration Background’ funded by the Landeszentrum Gesundheit Nordrhein-Westfalen, Germany, and by the project ‘Meaning of Patients’ Value Systems for Clinical Ethics’ funded by Istanbul University BAP (Project ID: 3085; Project Code: 55226). We would like to thank the Landeszentrum Gesundheit Nordrhein-Westfalen and Istanbul University BAP for their funding and Assoc. Prof. Dr. Rainer Brömer for his relevant comments and critical perusal of this manuscript.

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  1. Department of History of Medicine and Ethics, Istanbul University Faculty of Medicine, Hulusi Behçet Kütüphanesi Kat 2, 34093, Istanbul/Capa, Turkey

    Ilhan Ilkilic & Hakan Ertin

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  1. Ilhan Ilkilic
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Correspondence to Ilhan Ilkilic.

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Ilkilic, I., Ertin, H. Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan. Med Health Care and Philos 20, 561–570 (2017). https://doi.org/10.1007/s11019-017-9777-y

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