Blood During Ramadan

July 5, 2016

By Peter Young


The death toll in a series of three explosions at Ataturk International Airport in Istanbul has risen to 44, with 238 originally wounded and 94 currently hospitalized as of late last week. The airport reopened the morning after, cordoning off the sections where blasts had occurred, and the city of Istanbul is now in a state of mourning over innocent victims lost. These unfortunate events bring up an opportunity to discuss how differences in belief can influence medical ethics. Turkey, a predominantly Muslim nation, has culturally defined ethical considerations that translate to differences when providing healthcare.


The attacks in Turkey, for example, came in the middle of Ramadan, a month-long Muslim holiday where many fast during daylight hours. The act of fasting, already tough on the body, is not recommended for the young or light-weight. For a variety of reasons, blood banks in countries neighboring Turkey have faced shortages of blood products during the month of Ramadan. One obvious reason is that the act of donating may make a fasting person feel weaker and may force them to break their fast, if they need to eat or drink to replenish themselves. Others have a belief that donating blood somehow invalidates their fast. Fortunately for Turkey, Turks seem to have positive attitudes towards donating blood, although some do not fully understand related issues. In addition to positive attitudes, the Red Crescent, equivalent of the Red Cross, is well organized and was able to coordinate the movement of blood products from regional centers to Istanbul to treat those injured from last Monday’s attacks. A comment from the Red Crescent assured, “enough blood was available to treat all those who needed it.”


There are other ethical issues besides donating that Muslims consider during the holy month, one of which is accepting blood products. A case, published in the British Medical Journal in 2010, featured a Turkish man involved in a motor vehicle accident, who actively refused a treatment of life-saving serum because he believed it would break his fast, thus disrupting his religious practice. After examining the underlying principles in that case, namely the best medical interest of the patient versus patient autonomy, the authors of that paper concluded that autonomy should sometimes take a backseat to doing what is medically best for a patient, even if the treatment-refusing patient is competent. In a view-point that is starkly different from standards in Western medical ethics, the physicians further explained, “What is important in solving the ethical conflicts encountered in medical applications is to find the path that provides the least sacrifice of values, or in other words, the path that most conserves and protects values.” Compare that sentiment with the case of Jehovah’s witnesses who can refuse life-saving treatment in the U.S. and sometimes die as a result. Whether the authors’ remarks are wide-spread beliefs in Turkey, however, is unclear.


Also surrounding the question of donating blood in Turkey are other issues doctors may want to consider when treating Muslims during the month of Ramadan. Fasting during Ramadan, for example, has led to differences in blood pressure and HDL cholesterol. One could also imagine that fasting during the hot summer months can affect the total volume of water in the body, leading to differences in drug concentration and the potential need to adjust dosing. In fact, there is a subset of research within Turkey devoted to understanding physiologic differences that one might encounter during Ramadan fasting, including differences in Type 2 Diabetes treatment, differences in blood and saliva immunoglobulins, neonatal outcomes, and differences in cytokines and blood markers, among many others.


The differences in belief and religious practice may have important implications for American doctors who treat Turkish and/or Muslim patients. Understanding the wide spectrum of patient preferences and differences in the goals of care can prompt a discussion in the initial consultation, which will hopefully  lead to better patient-centered care.

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