Ethical considerations of Ramadan fasting in diabetic patients according to Shiite school of thought

The main purpose of this paper is to provide a discussion on: existing theories of permitting a Muslim to practice fasting during Ramadan (Shiite and Sunni), risk of fasting in diabetic patients and recommendations for reducing them, the rules of decision making, and the ethical obligations associated with diabetes care. Our main five subjects are:What is the definition of disease and who cannot and should not fast? The authority of different groups in Ramadan fasting. Evaluation of scientific evidences and specialist's recommendation Recognizing the responsible person for making a decision on who allows to fast? Ethical obligations of health providers, governments, and patients. In Islam the sick people (patients) are exempt from fasting during Ramadan, however, there is no precise definition between sickness and health. If fasting during Ramadan causes physical damage, then it is not allowed. The limits are determined based on the ability of the patient which is a qualitative and changeable criterion. Shiite and Sunni clerics have different perspectives in this regard. Sunni religious scholars consent to authority while Shiite approves the illegality or obligation. Currently, there is no certain defined status to restrict a diabetic patient from fasting, and we cannot precisely decide in which diabetic patients fasting is safe. Therefore, it is necessary to perform several controlled studies in this field to determine the impacts of Ramadan fasting in a wide variety of diabetic patients with various degrees of metabolic control. Our task in this study was to design a guideline, based on available Shiite comments, to define the conditions in which a diabetic patient is allowed or prohibited from Ramadan fasting.