Religious Fasting and Autonomy for the High-Risk Patient

Several cultural groups celebrate holidays that honor fasting rituals. Ramadan, the ninth month of the Islamic calendar, and Yom Kippur, the Jewish holiday of atonement, are two primary examples, typically involving a month of sunrise-to-sunset fasting and a 25-hour fast, respectively [6]. Fasting calls attention to marked moments in the year, bringing communities together in celebration and commemoration. However, while observers of the fast may feel a religious or spiritual impact, they will also feel a biological one. An empty stomach can be uncomfortable for anyone, but what about observers with preexisting medical conditions? What happens when a medical emergency occurs during the fasting period that could be improved by eating? The balance between patient autonomy and doctors’ discretion is always a focal question, but cultural motivations add an additional layer of complexity.

Patients with preexisting medical conditions face unique challenges while fasting. Individuals with cardiovascular disease have a heightened risk of dehydration, which can affect electrolyte balance and put added strain on the heart [3]. Cancer patients have demanding nutritional needs, and fasting can exacerbate the effects of chemotherapy, namely nausea [3]. Diabetes presents an especially intense case. Fasting can trigger extreme changes to blood sugar levels, even leading to diabetic ketoacidosis in some cases for those with type 1 diabetes [3]. A study done in the Middle East even found that instances of renal colic increased after Yom Kippur fasting [7]. 

Complications of this kind can be managed, however, which means that patients don’t necessarily need to abstain from fasting completely. Because religious fasting has a fixed duration and timing, medications can be changed to align with eating schedules [2]. For patients with diabetes, drugs with low hypoglycemic risk can be prioritized and glucose monitoring is strongly encouraged [2]. In order for these accommodations to be made, however, the patient and their doctor must have productive and honest conversations.

Assumptions about each others’ priorities can create unproductive tension between patient and doctor. One study even found evidence that Muslim patients were less likely to go to the doctor during Ramadan when they normally would have because they anticipated that their doctors would advise them against fasting [4]. Patients would rather avoid the interaction altogether than seek the care they need, perhaps out of fatigue from convincing previous doctors of the significance of the fast, or out of fear that they will have to abandon their religious practices. While many variations of Islamic and Jewish teachings do excuse the ill from fasting [1], it is up to the individual to decide whether they practice this or not. If a patient truly wants to fast, they will likely do so with or without their doctor’s guidance [5], so it is crucial that doctors educate themselves on their patients’ religious practices and drug prescriptions so that serious complications do not arise.

Ultimately, the patient has the right to autonomy but the physician also has an obligation to recommend beneficial treatment, so they must find a way to meet in the middle. In order to move forward in the patient’s best interest, treatment should be adjusted to the patient’s needs and religious practices, and this culturally-conscious care should be part of their long-term medical plan. In particular, high-risk patients should be consistently monitored so that if there is an emergency, the physician can take action to protect the patient’s life that is in alignment with the patient’s wishes. The patient should not have to choose between faith and health; medicine can make room for both.

Designed by: Leah Kim Reviewed by: Chloe Quan

References

[1] Alghafli, Z., Hatch, T., Rose, A., Abo-Zena, M., Marks, L., & Dollahite, D. (2019). A Qualitative Study of Ramadan: A Month of Fasting, Family, and Faith. Religions, 10(2), 123. https://doi.org/10.3390/rel10020123 

[2] American Diabetes Association Professional Practice Committee. (2024). 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2025. Diabetes Care, 48(Supplement_1), S86–S127. https://doi.org/10.2337/dc25-S005 

[3] Blogs & News. (2026). Doctors at Kaiser Permanente in MD, VA, DC. https://mydoctor.kaiserpermanente.org/mas/news/fasting-during-ramadan-with-health-conditions-2944846 

[4] Ilkilic, I., & Ertin, H. (2017). Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan. Medicine, Health Care, and Philosophy, 20(4), 561–570. https://doi.org/10.1007/s11019-017-9777-y 

[5] Fasting Safely with Diabetes | NIDDK. (2020, August 26). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/fasting-safely-with-diabetes 

[6] Congress, W. J. (n.d.). World Jewish Congress. World Jewish Congress. Retrieved October 1, 2026, from https://www.worldjewishcongress.org/en/news/the-muslim-ramadan-and-the-jewish-yom-kippur 

[7] Zilberman, D. E., Drori, T., Shvero, A., Mor, Y., Winkler, H. Z., & Kleinmann, N. (2021). A single day fasting may increase emergency room visits due to renal colic. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-86254-7