Question:
Assalamualaikum ustaz. Is it permissible for a person undergoing dialysis treatment to perform jamak Zohor and Asar although the dialysis centre is less than two marhalah? The reason is during the dialysis process, the patient cannot make any huge movements. Furthermore, it takes a long time, which is between 4 to 5 hours. If it starts at 3 p.m. then it will end at approximately 7 p.m. or later. Hope for an explanation.
Answer:
Alhamdulillah, praise and gratitude to Allah SWT for His countless blessings for us all. Praise and salutations to our beloved Prophet Muhammad PBUH, his family, companions and all those who follow his footsteps until the Last Day.
The Meaning of Dialysis and Its Treatments
According to MyHealth by the Ministry of Health Malaysia, dialysis is a blood cleansing process performed using a dialysis machine to perform the same function as a healthy human kidney. The dialysis process is usually done to remove metabolic wastes and excess fluid so that it does not accumulate in the body and to keep the body in a balanced state. There are two common ways to do it:
First: Peritoneal Dialysis (PD)
This method of dialysis requires dialysis fluid to be inserted into the peritoneum cavity in the abdomen (abdominal space) through a special tube (Tenchoff catheter) that is inserted permanently through a minor surgical procedure. The lining or membrane that covers the stomach (peritoneum) allows waste products and excess fluid to be absorbed from the blood into the dialysis fluid. This fluid is then removed from the body periodically.
Source: https://nkf.org.my/kidney-transplant/peritoneal-dialysis/
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD requires 4 or 6 exchanges a day at home, without the use of machines. This process can be done by the patient himself. Exchanges are a process in which sterile dialysis water is inserted into the abdomen and when removed, it also carries waste products and excess water from the body. The dialysis fluid is left in this cavity for 4 to 6 hours, then removed from the abdomen and replaced with new dialysis fluid.
- Continuous Cycling Peritoneal Dialysis (CCPD)
CCPD is performed at home using a machine called a cycler. The cycler can make shifts for 8 to 10 hours, usually at night while the patient is asleep.
Second: Haemodialysis (HD)
The artificial kidney (hemodialyzer) is connected to a filter machine that works to remove waste and excess fluid from the body. The procedure is performed by a special unit (hemodialysis unit) in the hospital and takes 4 hours to 5 hours per session (3 sessions per week). The patient will need a fistula so that blood from the body can flow to the artificial kidney. The surgeon will create this fistula by connecting the arterial blood vessels with the veins so that the venous blood vessels become larger and more like arterial blood vessels. [1]
Praying During Dialysis Treatment
In the above issue, we pray that Allah SWT grant health and cure as well as facilitation to those who are undergoing dialysis. We understand that the process of dialysis takes a long time. Thus, it doesn’t just affect a person’s physical but even his mental stability. This may affect the elderly who is going to perform prayer.
A person knows best of his own condition. We suggest the main solution is a discussion with the doctor to set the treatment time to be made in the morning as to not disturb the time of prayer. If this isn’t possible, the solution that we see is through two situations:
First: It is permissible for a person to pray while sitting during the dialysis process if there is a necessity. Thus, it is not necessary for a person to jamak or qadha’ (replace) the Asar prayer, rather perform it according to his capability.
From Imran bin Hussein RA: I suffered from haemorrhoids and asked Rasullullah PBUH regarding my prayer, the Prophet PBUH said:
صَلِّ قَائِمًا، فَإِنْ لَمْ تَسْتَطِعْ فَقَاعِدًا، فَإِنْ لَمْ تَسْتَطِعْ فَعَلَى جَنْبٍ
“Pray standing, but if you are unable, do it sitting; and if you are unable to do that, do it lying on your side.” [2]
Imam al-Nawawi explained: If a person (praying while standing) is when he fears a great burden or increase in pain, then it is permissible to pray while sitting and it isn’t necessary to repeat it. [3]
Likewise, according to the opinion stated by Imam Imam al-Ramli as cited by Syeikh Hasan bin Ahmad al-Kaf who said it is permissible for a person to pray sitting when there is masyaqqah (debility/burden) that can remove khusyuk in prayer. [4]
Imam al-Nawawi further stated in the book al-Majmu’ (4/226): The ummah has agreed that whoever is not able to pray while standing in the obligatory prayer, then he can perform it sitting and the prayer is not necessary to be repeated. Such is for the rewards (praying sitting) is not less than praying while standing, for he is given facilitation. In Sahih al-Bukhari it is stated that Rasullullah PBUH said:
إِذَا مَرِضَ الْعَبْدُ أَوْ سَافَرَ كُتِبَ لَهُ مَا كَانَ يَعْمَلُ مُقِيمًا صَحِيحًا
“When a man is ill or on a journey, what he was accustomed to do when staying at home and well will be recorded for him.” [5]
While Imam al-Syaukani when commenting on the above hadith of Imran bin Husein RA said: The hadith from Imran shows the permissibility for a person who experiences a debility which makes him unable to stand in prayer to sit. Whereas, if he is unable to sit, then he can lie on his side. [6]
Ibn Qudamah al-Maqdisi said: The ijma’ (agreement) is reached by scholars, whoever is unable to stand in prayer, then he can pray while sitting. [7]
Second: The meaning of “cannot make any huge movement” should be considered carefully. Is it so that he cannot even go to the bathroom? If he is able, then the same should be made for prayer. If he is not able to do so during the treatment, then jamak taqdim of the Zohor and Asar prayer can be performed without qasar (shortening), for qasar can only be performed during travels. The reason is we have to consider the condition of the patient where he will not be capable to perform prayer after treatment or he is concerned of the treatment takes longer and passes the time of Asar.
This matter should be considered carefully in detail so that the issue is understood correctly in its full framework and don’t make a hasty decision for an Islamic legal maxim state:
الْحُكْمُ عَلَى الشَّيْءِ فَرْعٌ عَنْ تَصَوُّرِهِ
“The ruling of something is built on the opinion on the entirety of the matter.”
According to al-Jurjani he said: “Tasawwur” is illustrating something accurately in one’s mind. The tasawwur in this maxim doesn’t mean solely an illustration of the zihin of the mind from something. [8]
This is emphasized by Abu al-Baqa’ al-Kafawi, who said: “Tasawwur sometimes means insight or knowledge. And it is not based on fraudulent tasawwur. Thus, tasawwur means in this maxim is tasawwur which is complete with comprehensive knowledge in a certain matter. The reason is the tasawwur is dhabit in the zihin and thought safe from mistake.” [9]
Thus, a sahih depiction and in-depth knowledge in every branch of the issue presented in research is the basis or principle. The reason is knowing the truth of something and understanding all of its meanings are considered the basis in a depiction.
Wallahu a’lam.
[1] See Hemodialisis at the Ministry of Health Malaysia official portal. [http://www.myhealth.gov.my/hemodialisis/]
[3] See al-Majmu’ Syarh al-Muhazzab, 4/310
[4] See al-Taqrirat al-Sadidah, pg. 214
