I recently had a home visit for one elderly male whom I had advised not to fast during Ramzan because of his medical condition. When I met him again, his blood pressure was stable, his medicines were working, but something else was clearly unsettled. “Doctor sahib, I feel bad,” he said quietly. “Everyone in the house is fasting. I am the only one not fasting.”

Clinically, his condition was straightforward. He had advanced coronary artery disease, long-standing diabetes mellitus and chronic kidney disease. Prolonged fasting in such a patient can precipitate hypoglycaemia, dehydration, electrolyte imbalance, or even cardiac events. From a medical perspective, advising him not to fast was a protective decision.

Yet the real issue that day was not physiological. It was psychological. In medicine, this feeling is often described as illness-related guilt or health-related guilt. It occurs when a person feels they are failing in a religious duty because of a health limitation. In religious contexts, it can also overlap with what psychologists call spiritual distress, a state in which illness interferes with a person’s ability to practice valued spiritual rituals.

For many seniors, Ramzan is not merely a month of fasting. It is identity, routine and continuity with decades of lived faith. A person who has fasted for forty or fifty years does not easily accept the idea that their body can........

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