When Illness Comes

1. 01Illness in a believer's lifeTreatment and tawakkul together; illness as expiation
2. 02The rule the whole book runs onAbility, not hardship, and who decides
3. 03Purity in a hospital bedDrips, casts, dressings, catheters, stomas, sheets
4. 04Praying through illnessThe posture ladder, gesturing, qibla, combining
5. 05Unconsciousness, anaesthesia and comaWhat the texts say, and where they stop
6. 06Fasting and illnessMaking up days or fidyah; pregnancy; procedures
7. 07Medicines, doctors and consentHaram ingredients, necessity, cross-gender care
8. 08The patient's heartPatience, complaint to Allah, duas, ruqyah, low mood
9. 09Old age and dementiaWorship as abilities fade; a parent's old age
10. 10The visitor and the carerWhat to do, what to say, what the carer is owed
11. 11When recovery does not comeThe will, debts, treatment limits, the last words
12. 12A bedside referenceOne table, and the questions to ask

Illness arrives before anyone has time to study: a phone call, a fall, a scan result. This book follows the order those days unfold, starting with how a believer should see what is happening.

Seek treatment; it is part of trusting Allah

Going to a doctor is not a lack of trust in Allah. Treatment is a means He created:

When the desert Arabs asked the Prophet ﷺ directly whether they should seek treatment, he answered with a command:

Old age is the one exception, and Chapter 9 returns to it. For everything else the believer takes the medicine and relies on Allah, who alone makes it work. The site's Ruqyah page puts it plainly: "Neglecting medicine is not tawakkul; it is neglect."

Nothing is wasted

None of it is lost. Pain, fatigue, fear and the long boredom of a hospital bed all count:

For the patient who grieves the worship they can no longer do:

What you used to do while well is still being written for you.

Every ruling in this book comes from one principle: Allah asks for what you are able to do. What you cannot do falls away; what you can do does not fall away with it.

The site's Disability page reads them together: the part you cannot do "falls away entirely, without sin, without substitute, without apology," while "the part you can do does not fall away with it." A man who cannot stand prays sitting. Almost nothing in this book is an exemption from worship; it is a change in its form.

What "cannot" means

The site's Prayer of the Sick page records that inability "does not require total incapacity." It covers an act that "would cause real harm, aggravate the sickness, or delay recovery." Real pain counts too (Disability page).

Who decides

The same pages name two judges: the patient's own settled experience of their body, or a trustworthy physician.

Avoid both errors: a concession taken for mild inconvenience, and "Pushing past real harm to prove your sincerity" (Disability page).

A cannula in the hand, a dressing on the arm, perhaps a catheter: this is where a patient first gets stuck. Purification comes down in steps, and every step is valid.

The verse that names the sick

Allah names illness Himself. The site's Tayammum page counts the case where "using water would cause or worsen illness/harm"; the Disability page adds water you cannot reach or cannot use without help.

A man with a head wound was told he had no concession; he bathed and died. The Prophet ﷺ said:

The ladder for purification

On the evidence. qa-922 states that "the narrations specifically about wiping over a splint are weak", and rests the ruling on 64:16 and 22:78 instead; so does this book. Prayers prayed in that state are not repeated, per the majority (qa-922).

Tayammum on a ward. The Tayammum page accepts "any clean natural surface (sand, stone, dust)" and calls manufactured surfaces free of dust "more doubtful". A clean stone in the bedside locker serves a long stay (a practical suggestion, not a text).

Someone else may do it for you. "It is your purification; the hands are simply borrowed" (Disability page).

Catheters, stomas and continuous discharge

No page on the site names a catheter or a stoma. What it does set out is the ruling on the person whose nullifier is continuous and beyond control, the ṣāḥib al-ʿudhr. Its root is the answer to Fāṭimah bint Abī Ḥubaysh, who had continuous bleeding:

The site's Chronic Excuses page records that the scholars extended this, by analogy, to "the one afflicted with chronic urine drip … the one with a wound that will not stop seeping, or persistent incontinence."

In practice (Chronic Excuses page):

Soiled sheets, gowns and dressings

"Impurity (najāsah) on the body or clothing that you genuinely cannot remove or avoid is excused. You remove what you can, and pray" (Disability page). Ask for clean linen if it can be had without real hardship; if not, do not delay the prayer past its time waiting for it.

"Illness lightens the form of the prayer — it never lifts the prayer itself" (Prayer of the Sick page). While the mind is present, the prayer is owed.

The posture ladder

ʿImrān ibn Ḥuṣayn had piles and asked how to pray. The answer is the whole of the ladder:

The table is the site's (Disability page). Go down only as far as you must; sujūd lower than rukūʿ; do not raise a pillow to your forehead. The wording "then on your back" is a disputed addition, so stage 5 rests on 2:286; a report about removing a sick man's cushion is flagged weak, so gesturing rests on Bukhārī 1117 and 64:16.

Qibla when the bed cannot turn

No text addresses a bed fixed to a wall. The site records that after real effort, a mistaken direction leaves "your prayer is still valid, for Allah does not burden a soul beyond its capacity" (qa-627), and for a vehicle asks for the qibla "at least for the opening takbīr and stay with it as far as you can" (qa-988).

On a ward (this book's reading): ask for the bed to be angled; if not, turn your face if you can; if not, pray as you are.

Pray in the time, even if imperfectly

Avoid "Delaying a prayer past its time waiting for help to arrive" (Disability page). Prayers performed under a concession are not repeated: "the majority of scholars hold there is nothing to repeat."

Combining prayers for illness: an honest disagreement

The evidence cited for combining in illness is the report of Ibn ʿAbbās about the Prophet ﷺ in Madinah:

A narrator, Ayyub, suggests, "Perhaps those were rainy nights." Illness is not mentioned: "there is no explicit ṣaḥīḥ marfūʿ ḥadīth that names 'illness' itself as a cause for combining" (Combining Prayers page). The site records the schools:

• Ḥanbalī: broadest; permitted for illness when each prayer on time is a real hardship (Ibn Bāz and Ibn ʿUthaymīn cite continual pain or dialysis).
• Mālikī: travel and rain under conditions, "also for some illness".
• Shāfiʿī: travel and rain under conditions; more restrictive on illness.
• Ḥanafī: only at ʿArafah and Muzdalifah; the report is a "combining in form", one prayer at the end of its time and the next at the start of its own.

Both prayers are still prayed in full and in order. "If in doubt, praying each prayer in its own time is safest and is agreed upon by all" (Prayer of the Sick page).

You go under before Ẓuhr and wake after Maghrib. A relative is sedated in intensive care for a week. Are the missed prayers owed? This chapter gives what the texts say, and where they stop.

What the texts say

Two situations are settled. Prayers missed through sleep or forgetting are prayed when the person wakes or remembers, without sin:

A second text names the states in which the obligation is lifted altogether:

The sleeper makes up the prayer on waking. Where reason is truly absent, obligation does not attach (Mental Health and Disability pages).

Where the texts stop

What a patient can do meanwhile

Practical steps from rulings the site does give; not a ruling on unconsciousness itself:

The Quran addresses the sick in the verses that command the fast:

Temporary or lasting: the question that decides everything

Ibn ʿAbbās explained who the "ransom" (fidyah) is for:

So "the rule sorts by prognosis, not by diagnosis" (Disability page).

The classical measure is "one mudd (roughly 600–750 grams) of a staple food, or its cooked equivalent, per missed day"; many councils convert it to the cost of a meal (qa-145). On diabetes, qa-148 says to "consult a knowledgeable and trustworthy physician": fidyah where fasting "poses a real risk such as severe hypoglycemia, dehydration, or organ strain"; otherwise "the normal obligation and its qada stand."

Pregnancy and nursing

What she owes afterwards is disputed (qa-147). Many Ḥanafī and Shāfiʿī scholars require making up the days. A view associated with some Shāfiʿī and Ḥanbalī scholars adds fidyah if she feared for the child rather than herself. Others hold making up alone suffices. In every case "the safety of mother and child comes first."

Medical procedures during the fast

Vomiting.

The site's page Vomiting and the Fast explains that "atonement" here means making up the day (qaḍāʾ), not kaffārah. Vomiting from illness or medication does not break the fast; inducing it does. The page also notes an early question over the chain, and a Ḥanafī "mouthful" threshold.

Medication timing. Moving doses to the night is a decision for the prescriber; "rearranging a regimen to protect a fast that Allah has already excused is not piety" (Disability page).

When a medicine contains something haram

The starting point is strict:

Told that wine was a medicine, he said: "No it is a disease" (Sunan Abī Dāwūd 3873 Sahih).

Against this stands the verse of necessity:

The Medical Fiqh page gives two routes between them:

• Transformation (istiḥālah): "the ruling follows what it has become, not what it was." Some apply this to processed gelatin; others judge the change incomplete.
• Necessity: where no equally effective lawful alternative exists, "measured, as always, by its extent."

The page records that "the major contemporary fatwa bodies permit vaccination on one or both of these grounds, and permit medicines containing transformed or trace ingredients where need calls for them." In practice, ask the pharmacist for an alternative; if none works as well, take what is prescribed without guilt.

Is treatment obligatory?

The site notes that "seeking treatment is not universally obligatory in the view of the majority" (qa-973), and that where illness is destroying the ability to worship, work or care for family, "seeking treatment moves from permitted toward obligatory, exactly as with bodily disease" (Mental Health page).

Being examined by a doctor of the other sex

qa-847: "permissible where there is a genuine need", with a preferred order when competence is comparable (Muslim woman, non-Muslim woman, Muslim man, non-Muslim man) and these conditions:

Its evidence is necessity (Quran 6:119) and the women Companions who treated the wounded:

Consent and the family

The site has no general fiqh of consent. Its Medical Fiqh page requires "free, informed consent — no coercion" for donation, and applies "There should be neither harming nor reciprocating harm" (Sunan Ibn Mājah 2340 Sahih) to "the physician, the patient, and the donor alike." A family helps a capable patient decide; it does not decide over their head.

The rulings are the easier part. The hard part is the day the doctor stops saying "when" and starts saying "if".

Complain, but to Allah

Yaʿqūb, having lost Yūsuf and then a second son, did not pretend to be at peace:

Patience is not silence. The Mental Health page draws the line: "Speaking of your pain to a doctor is not a complaint against Allah … the complaint against Allah is the accusation of the heart, not the description of the wound." Tell the nurse where it hurts. Tell Allah everything.

Do not wish for death

"A lifeline offered inside a prohibition" (Mental Health page).

The duas of distress

Both can be said lying down, in any language.

Patience as a choice, not a refusal of care

A woman with epilepsy was offered: "If you wish, be patient and you will have (enter) Paradise; and if you wish, I will invoke Allah to cure you." She chose patience, and asked him to pray she would not become uncovered, which he did (Ṣaḥīḥ al-Bukhārī 5652). The choice was between patience and a duʿāʾ, not a refusal of medicine.

Ruqyah beside the treatment, never instead of it

Ruqyah and medicine "go together" (Ruqyah page); Chapter 10 gives the words. Beware "anyone — including a self-styled 'raqi' — who tells a sufferer to stop prescribed psychiatric medication" (Mental Health page).

When low mood needs a professional

Long illness often brings depression, in patient and carer. See "a doctor, psychiatrist, or licensed therapist — without delay" when (Mental Health page):

• Low mood or loss of interest persists for weeks, not lifting with rest, company or worship.
• Sleep, appetite or concentration are failing, or panic or withdrawal has taken over.
• "Any thought of death as a relief, of self-harm, or of 'everyone would be better off without me' — this one is an emergency, today, not eventually."

"None of this conflicts with tawakkul."

Old age is the one illness with no remedy (Sunan Abī Dāwūd 3855, Chapter 1), and the stage where the rest of this book meets: every rule of ability, as abilities go one by one.

Worship as abilities fade

Chapters 3 and 4 apply unchanged: the posture ladder, tayammum for one who cannot reach the tap, wuḍūʾ performed by another. With age the concessions simply become permanent.

Fasting in old age

This is the case Ibn ʿAbbās named: "old men and old women who have no strength to fast" (Ṣaḥīḥ al-Bukhārī 4505). They owe fidyah, not days they will never make up (Chapter 6).

Ḥajj by proxy

The proxy must first have performed his own Ḥajj: "perform hajj on your own behalf, then perform it on behalf of Shubrumah" (Sunan Abī Dāwūd 1811 Sahih). The inability must be permanent: "A condition expected to improve is a reason to wait, not to send a proxy." Further details, such as who pays or what if the person recovers, "are not all agreed" (Disability page).

When the mind goes: dementia

The pen is lifted "from the insane until he comes back to his senses or recovers" (Sunan al-Nasāʾī 3432 Sahih). "Where reason is genuinely absent, the obligations do not attach"; where it "is present but partial, what can be understood and performed is taught and encouraged, gently and at the person's own pace" (Disability page).

Meanwhile: prompt gently, pray alongside them, accept whatever form they manage, and do not scold.

The child's duty in a parent's old age

The duty "intensifies, not lessens, as parents become physically or mentally dependent — frail, forgetful, or in need of daily care" (qa-231). The same answer records that a care facility "is not itself forbidden" where genuine need requires it, "provided the child still visits often, funds their care, and preserves their dignity"; what the verse forbids is "emotional abandonment".

The visit is a right, not a courtesy

And: "Feed the hungry, visit the sick, and set free the captives" (Ṣaḥīḥ al-Bukhārī 5649). The majority hold it a communal obligation, closer to individually binding for relatives and neighbours (qa-948). And the visitor walks in a garden:

What to do

What to say

He ﷺ would say: "No harm will befall you! May Allah cure you!" (Ṣaḥīḥ al-Bukhārī 3616), or "Don't worry, if Allah will, it will be expiation (for your sins)" (Ṣaḥīḥ al-Bukhārī 5656). When a feverish bedouin insisted the fever would kill him, he did not argue: "Then, yes, it is so" (5656).

Talbina: food for the sick and the grieving

The narration gives no recipe; check any you are handed against the patient's diet.

The carer

"The one who looks after a widow or a poor person is like a Mujahid (warrior) who fights for Allah's Cause, or like him who performs prayers all the night and fasts all the day" (Ṣaḥīḥ al-Bukhārī 5353). The hadith names the widow and the poor; extending it to the carer is ijtihād "drawing on the text's own logic rather than a second narration" (Disability page), which also sets out the carer's concessions:

• Congregation and Jumuʿah: where leaving would put the patient at real risk, pray at home, in time.
• Fasting: care is no excuse by itself; if it makes fasting harmful to the carer, 2:184–185 applies to them.
• Missed prayers: one missed through unavoidable sleep after a night of care is made up on waking, without sin.
• Sharing the load: "Nothing in the Sharīʿah requires one relative — usually a mother, a wife or a sister — to absorb the whole of it in silence." Seeking medical and respite help "is permitted and often obligatory."

This chapter is best read while there is still time to act on it.

Write the will now

The limit was set at a sickbed. Visiting the ill Saʿd ibn Abī Waqqāṣ, who asked to bequeath all, then half, the Prophet ﷺ said: "Yes, one third, yet even one third is too much. It is better for you to leave your inheritors wealthy than to leave them poor begging others" (Ṣaḥīḥ al-Bukhārī 2742).

Up to one third, to non-heirs or good causes; "no bequest to an heir who already inherits a fixed share" (Wasiyyah page). Register it as local law requires.

Settle debts, or write them down

Debts, "to Allah (e.g. unpaid zakat, kaffārah) and to people", are paid before the bequest (Wasiyyah page). Write a list: what you owe, what is owed to you, trusts you hold, fasts or zakat outstanding.

Futile treatment is not euthanasia

• Actively ending a life to end suffering is forbidden, whether the patient asks for it or not. The Prophet ﷺ related of a man who could not bear a wound and cut his hand until he bled to death: "Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise'" (Ṣaḥīḥ al-Bukhārī 3463).
• Withholding or withdrawing futile treatment is different. "When trustworthy physicians judge that a machine no longer heals but only prolongs the mechanics of dying, most contemporary scholars hold that withholding or withdrawing such futile measures is permissible — it is not killing but ceasing to obstruct a death Allah has decreed."

"Nothing may be given to hasten death, while ordinary care — nutrition, hydration, cleanliness, and pain relief given to relieve pain (not to kill) — continues to the end" (Medical Fiqh page).

Think well of Allah

The last words

Prompt the testimony gently, "without harshly ordering or pressuring him", and do not press for repetition (qa-678). What follows death is on the site's Janazah page and in its Janazah ebook.

A summary; the chapter holds the evidence and any disagreement.

Questions to take to a trusted local scholar

1. Does my catheter or stoma count as a continuous excuse, and how do I renew wuḍūʾ?
2. May I combine prayers during this illness, and for how long?
3. I (or my relative) was unconscious for this long: are the missed prayers owed?
4. Is my condition temporary or lasting for the purpose of fasting: make up the days, or fidyah?
5. For a parent with dementia: which prayers and fasts are still asked of them, and is fidyah owed?
6. For end-of-life decisions: what is the family's role in withdrawing treatment?

Questions to take to the treating physician

1. Will washing this limb or site cause harm, and for how long must it stay dry?
2. Is standing, sitting or bending safe for me, and from when?
3. Is fasting safe for me this Ramadan? Is my condition expected to improve?
4. Can any daytime doses be moved to the night without loss of effect?
5. Does this medicine contain animal-derived or alcohol ingredients, and is there an equal alternative?
6. May I have a chaperone or a doctor of my own sex for this examination?

O Allah, Lord of the people, remove the trouble and heal every patient who reads this, and those who care for them. You are the Healer.