Ruling on injections and intravenous fluids for one who is fasting, and the impact of the intention (niyyah) on invalidating the fast
Question

When a patient goes to the doctor in the hospital or the clinic, what is his intention? Is his intention to eat and drink? What is his role in choosing the way of healing and recovery? Can he decide on a particular type and method of treatment, or change the treatment plan? In fact, when the patient goes to see a doctor in the hospital, his only intention is to seek treatment for a symptom or illness, or a health emergency that has befallen him, or a health problem that he has found out about, and when he meets the doctor, he surrenders his affairs to him, without any discussion, except a few questions about his health and sickness. With regard to intentions, when seeking treatment the patient has no intention of breaking the fast, and when the doctor agrees to treat the patient, he does not intend to invalidate the patient’s fast. Rather those who determine whether or not the sick person’s fast is valid, when the doctors subject him to a particular course of treatment, are the scholars – may Allah bless them. For example, they have ruled that intravenous injections do not invalidate the fast, without discussing the amount of the injected substance, such as what amount does not invalidate the fast and what amount does invalidate it. Thus the ruling is open-ended. But when they discussed saline (salt) or sugar solutions, they asked whether the solution was for the purpose of nutrition or for medical treatment. If it is for the purpose of nutrition, then it breaks the fast, and if it is for medical treatment it does not break the fast. With all due respect to them for raising this point, it contradicts the fact that here we are talking about the hospital setting, where every action is done according to the doctors’ instructions for the treatment of patients; I mean that everything that happens in the hospital is for the purpose of medical treatment, even if the doctor prescribes nutrients, as in the case of sunstroke and heatstroke, where the saline solution is only used for the purpose of rehydrating the patient, who is not able to drink because of vomiting, and he refuses to break his fast and then make up the day after Ramadan, in accordance with the concession that is granted, because those who are brought to the hospital in that condition are people who work in the construction industry or in iron and steel foundries, for example; if they have to break the fast, they would have to do so every day, and they would not accept that.
Praise be to Allah.Firstly:
The discussions of the fuqaha’ about things that invalidate the fast have nothing to do with the intention (niyyah) of the sick person or of the doctor; rather the things that break the fast are either mentioned in the religious texts or are analogous to those things.
Among the things that are mentioned in the religious texts are eating and drinking, as Allah, may He be exalted, says (interpretation of the meaning):
“And eat and drink until the white thread of dawn becomes distinct to you from the black thread [of night]. Then complete the fast until the sunset” [al-Baqarah 2:187].
So it is permissible to eat and drink until the break of dawn, then it is enjoined to refrain from eating and drinking until sunset, which is when the night begins.
Al-Bukhaari (1903) narrated that Abu Hurayrah (may Allah be pleased with him) said: The Messenger of Allah (blessings and peace of Allah be upon him) said: “Whoever does not give up false speech and acting thereon, Allah has no need of his giving up his food and drink.”
Al-Bukhaari (1933) and Muslim (1155) narrated that Abu Hurayrah (may Allah be pleased with him) said: The Messenger of Allah (blessings and peace of Allah be upon him) said: “Whoever forgets that he is fasting and eats or drinks, let him complete his fast, for Allah has fed him and given him to drink.”
And there is other evidence to indicate that eating and drinking during the day in Ramadan is among the things that invalidate the fast.
Many of the fuqaha’ added to that anything that reaches the stomach, whether it is through the same channel as food and drink, or otherwise.
Some of them limited it to invalidating the fast with that which comes under the same heading as eating and drinking, such as nutritional injections.
No doubt all injections and solutions are for the purpose of medical treatment, but some injections are for the purpose of nourishment which takes the place of food and drink, and others are not. As for solutions – whether sugar or saline – that are administered intravenously, they provide nourishment and invalidate the fast, unlike solutions that are used to wash the bladder, which do not invalidate the fast, as we shall see below.
We have previously discussed things that invalidate the fast, in the answer to question no. 38023. Among other things, we said there:
The fourth of the things that invalidate the fast is anything that is regarded as coming under the same heading as eating and drinking.
This includes two things: 
i. Transfusion of blood to one who is fasting – such as if he bleeds heavily and is given a blood transfusion. This invalidates the fast because blood is the ultimate destination of nourishment through food and drink.
ii. Receiving via a needle (as in the case of a drip) nourishing substances which take the place of food and drink, because this is the same as food and drink. Shaykh Ibn ‘Uthaymeen, Majaalis Shahr Ramadaan, p. 70. 
As for injections that are not an alternative to food and drink; rather they are for the purpose of medical treatment – such as penicillin, insulin, treatments to energise the body, or vaccinations – they do not affect the fast, whether they are intramuscular or intravenous.
Fatawa Muhammad ibn Ibraaheem (4/189).
But to be on the safe side, these injections may be administered at night.
Kidney dialysis, which requires removal of blood to clean it, then returning it with the addition to the blood of some chemical and nutritional substances, such as sugars and salts and the like, is regarded as invalidating the fast.
End quote. Fatawa al-Lajnah ad-Daa’imah (10/19).
In the answer to question no. 233663, we explained that saline solutions that are given to some patients intravenously do invalidate the fast, because they come under the heading of nutrients, as they contain salts and fluids that enter the bloodstream and benefit the body.
Defining what is regarded as nutritional and non-nutritional, Shaykh Ibn ‘Uthaymeen (may Allah have mercy on him) said: The scholars regarded as invalidating the fast everything that comes under the same heading as food and drink, such as nutritional injections.
That which energises the body or heals sickness is not regarded as nutritional; rather nutritional injections are an alternative to food and drink. Based on that, all injections that are not alternatives to food and drink do not invalidate the fast, whether they are administered intravenously or via injection in the thigh or elsewhere on the body.
End quote from Majmoo‘ Fatawa wa Rasaa’il al-‘Uthaymeen (19/199).
It is appropriate to quote here the text of a statement made by the Islamic Fiqh Council concerning things that invalidate the fast in the medical field.
The session of the Islamic Fiqh Council held during its tenth conference in Jeddah, in the Kingdom of Saudi Arabia, 23-28 Safar 1418 AH (28 June-3 July 1997 CE) – after studying the research presented to the Council on the topic of what invalidates the fast in the medical field, and the studies, research and recommendations issued by the ninth Medical Fiqh Conference held by the Islamic Association for Medical Sciences, in cooperation with the Council and other bodies in Casablanca, Morocco, 9-12 Safar 1418 AH (14-17 June 1997 CE), and after listening to the discussion that took place on this topic with the participation of fuqaha’ and doctors, taking into account the evidence from the Qur’an and Sunnah, and the views of the fuqaha’ – 
has determined the following:
1 – The following things do not have any effect on the fast:
i. Eye drops, ear drops, ear syringing, nose drops and nasal sprays – so long as one avoids swallowing any material that may reach the throat.
ii. Tablets or lozenges that are placed beneath the tongue for the treatment of angina pectoris etc., so long as one avoids swallowing any material that reaches the throat.
iii. Vaginal pessaries, douching, use of a speculum, or internal digital examination.
iv. Introduction of a scope or coil (IUD), etc., into the uterus.
v. Introduction of a scope or catheter into the urethra (male of female), or injection of dyes for diagnostic imaging, or of medication, or cleaning of the bladder.
vi. Drilling of teeth (prior to filling), extraction or polishing of teeth, using a miswaak or toothbrush, so long as one avoids swallowing any material that reaches the throat.
vii. Rinsing, gargling or applying topical treatment in the mouth, so long as one avoids swallowing any material that reaches the throat.
viii. Injections, whether subcutaneous, intra-muscular or intra-venous – with the exception of those used for purposes of nutrition.
ix. Oxygen.
x. Anaesthetics, so long as they do not supply nutrition to the patient.
xi. Medicines absorbed through the skin, such as creams, lotions and patches used to administer medication through the skin.
xii. Introduction of a catheter into the veins in order to examine or treat the vessels of the heart or other organs.
xiii. Laparoscopy for the purpose of diagnosis or surgical treatment of the abdominal organs.
xiv. Biopsies of the liver and other organs, so long as this is not accompanied by the administration of nutrients.
xv. Gastroscopy, so long as this is not accompanied by the administration of nutrients.
xvi. Introduction of medicine or instruments into the brain or spinal cord.
xvii. Involuntary vomiting (as opposed to self-induced vomiting).
2 – The Muslim doctor should advise his patient to postpone the above-described treatments and procedures until after he has broken his fast, if it is safe to do so and will not cause any harm (even if these procedures will not have any effect on his fast).
Secondly:
Workers who are working in the heat and sun and are adversely affected thereby, such as those who work in construction or in iron and steel foundries, have no concession allowing them to break the fast, unless they reach a point of exhaustion where they fear that they may die of thirst or become very ill. Such a worker should intend to fast from the night before and start his day fasting, then if he experiences exhaustion and extreme hardship, he may break his fast to the extent that will protect his well-being, then refrain from eating and drinking for the rest of that day, then make it up later on.
Your saying that he will not have any opportunity to make up the fast is not correct. He can fast on his days off, even if he takes days off for that purpose. If this worker resorts to using saline or salt solutions, that will not help him, because that will also invalidate the fast, as mentioned above, and this action is regarded as a trick or loophole, and is haram.
Hence it says in Fatawa al-Lajnah ad-Daa’imah li’l-Iftaa’ (10/252):
It is permissible to receive medical treatment in the form of an injection into a muscle or vein, for one who is fasting during the day in Ramadan, but it is not permissible for the fasting person to be given a nutritional injection during the day in Ramadan, because that comes under the same ruling as eating and drinking, and using such injections is regarded as a trick or loophole. If it is possible to give the injection into the muscle or vein at night, that is preferable. End quote.
For more information on fasting for those whose jobs involve hard physical labour, please see the answers to questions no. 43772 and 12592.
Thirdly:
The niyyah (intention) that could have an impact in this regard, is in the case of one who is using tricks to avoid fasting. So if a person travels in order to be able to break his fast, both travelling and breaking the fast are haram for him. That is in contrast to one who travels without such an intention.
With regard to travelling and breaking the fast, it says in Kashshaaf al-Qinaa‘ (2/312), which is a Hanbali book:
If a person travels so that he can break the fast, both actions – i.e., travelling and breaking the fast – become haram for him, because there is no reason for travelling except as an excuse to break the fast. As for the prohibition on breaking the fast, it is because there is no reason to allow it. As for the prohibition on travelling, it is because it is being used as a means to break the fast, which is haram. End quote.
And Allah knows best.