The comprehensive principle regarding the prayer of the sick person

Imran ibn Husayn, may Allah be pleased with him, asked the Prophet, peace and blessings be upon him, about prayer because of an illness he had. He said:

"I had hemorrhoids, so I asked the Prophet, peace and blessings be upon him, about prayer. He said: Pray standing; if you cannot, then sitting; and if you cannot, then on your side."

Narrated by al-Bukhari.

Arabic wording of the central hadith:

صَلِّ قَائِمًا، فَإِنْ لَمْ تَسْتَطِعْ فَقَاعِدًا، فَإِنْ لَمْ تَسْتَطِعْ فَعَلَى جَنْبٍ.

The order of the sick person's prayer is therefore as follows:

1. He prays standing if he is able.
2. If he is unable to stand, he prays sitting.
3. If he is unable to sit, he prays on his side.
4. If he is unable to pray on his side, he prays lying on his back according to his ability.

The sick person does not move from one form to a lower form merely for comfort or slight hardship. Rather, he does in every pillar what he is able to do.

First: Praying standing when able

Standing is a pillar in the obligatory prayer for the one who is able. Whoever can stand without harm and without severe hardship must pray standing, even if he needs to lean on a wall, cane, walker, or someone who helps him, as long as that is safe and possible.

It is not required that inability be total for sitting to become permissible. Severe hardship, fear of falling, overwhelming dizziness, or fear that the illness will worsen or recovery will be delayed, based on clear experience or the guidance of a trustworthy specialist doctor, is attached to inability. As for ordinary tiredness or slight pain that is normally bearable, it does not remove the pillar of standing.

Whoever can stand for only part of the prayer

Whoever is able to stand for a period that is not enough for the whole prayer stands as much as he is able, then sits when he becomes unable. If he is able to say the opening takbir and recite while standing, he does that, then sits when severe hardship reaches him.

If he began the prayer sitting and his ability improved during it, he must stand for the remaining places where standing is obligatory, as long as he is able to do so without recognized harm.

Likewise, if he began the prayer standing and then inability, dizziness, or severe pain occurred, he sits and completes his prayer according to his ability. He is not required to expose himself to falling.

The principle is that ability to perform part of a pillar makes that part obligatory, and what he is able to do of the other pillars of prayer does not fall because he is unable to perform another pillar.

Whoever can stand but cannot bow or prostrate

If the sick person can stand but cannot bow or prostrate, standing does not fall from him:

1. He says takbir and recites standing.
2. If he can perform the normal bowing, he bows; otherwise, he bends for bowing as much as he is able.
3. If he can sit after that, he sits, then prostrates on the ground if he is able.
4. If he is unable to prostrate on the ground, he gestures with his head for prostration and makes the gesture for prostration lower than the gesture for bowing.

Whoever can bow but cannot prostrate performs a complete bowing, then gestures only for prostration. He may not leave the standing or bowing that he is able to do merely because he is unable to prostrate.

If he can stand but cannot sit, he prays standing, performs whatever bowing he can, gestures with his head for whatever he cannot do of bowing or prostration, makes the gesture of prostration lower than the gesture of bowing, and says the tashahhud and salam while standing. He does not move to lying down while he is able to stand.

Second: How does a sick person pray sitting?

Whoever is unable to stand, or standing causes him severe hardship, prays sitting on the floor or on a chair, and he chooses the form easiest for him. He may sit cross-legged, in the iftirash position, or in any posture he is able to maintain. The aim is to perform the prayer with humility and stability without harm.

He sits for tashahhud in the usual form if he is able. If that is difficult, he sits in whatever form is easy for him.

The practical form is:

1. He faces the qiblah and says the opening takbir while sitting.
2. He recites al-Fatihah and whatever is easy from the Quran.
3. If he is able to bow with a usual bending while sitting, he does so; otherwise, he bends as much as he is able.
4. He rises from bowing and becomes still.
5. If he is able to prostrate on the ground, he must prostrate on it.
6. If he is unable to prostrate, he gestures with his head and makes the prostration lower than the bowing.
7. He completes the rest of the prayer in this form and says the prescribed remembrances and words in their proper places.

Third: How does a sick person pray on a chair?

The chair is a means for the sick person who needs it. It is not an independent form that drops the pillars he is able to perform. Therefore, the worshiper uses it according to his need:

1. If he can stand, he stands during the standing position and recites standing, then sits at the point he is unable to perform.
2. If he is unable to stand, he says takbir and recites while sitting on the chair.
3. He bows by bending the head and torso as much as he is able.
4. If he is able to prostrate on the ground, he must prostrate on it, even if he recited while sitting.
5. If he is unable to prostrate, he gestures for it with his head and makes prostration lower than bowing.
6. He places his hands on his knees in bowing. In prostration, he places them on the ground if he is able; otherwise, he places them on his knees.

It is not prescribed for the sick person to raise a pillow, table, or board to his face to prostrate on it. Rather, he prostrates on the ground if he is able; otherwise, he gestures with his head.

It is established from Ibn Umar, may Allah be pleased with them both, that he used to say: "If the sick person is unable to prostrate, he gestures with his head, and he does not raise anything to his forehead." This is the view of most scholars from the early and later generations.

The one praying on a chair in the mosque should not harm those behind him or cut the row without need. He should place the chair in a way that achieves alignment with the row as much as possible without exposing himself to falling.

Fourth: How does a sick person pray on his side?

If the sick person is unable to sit, he prays on his side, with his face and chest toward the qiblah. It is better for him to be on his right side if that is easy. If the left side is easier for him, or the right side is not possible, he prays on the left and there is no blame.

He prays as follows:

1. He intends the prayer and says the opening takbir.
2. He recites al-Fatihah and whatever is easy.
3. He gestures with his head for bowing.
4. He raises his head as much as he is able when rising from bowing.
5. He gestures for prostration with a gesture lower than bowing.
6. He says the prescribed remembrances in bowing, rising, prostration, sitting, and tashahhud according to their places.

If he cannot move his head, he prays according to his condition. He intends in his heart the transitions between standing, bowing, prostration, and sitting, and he recites and says the remembrances with his tongue if he is able. There is no basis for taking finger gestures as a fixed substitute for bowing and prostration.

Fifth: Praying while lying on the back

If the sick person is unable to pray on his side, he prays lying on his back, placing his feet toward the qiblah if possible, and raising his head slightly so that his face is toward the qiblah if that does not harm him. He then gestures with his head for bowing and prostration, making prostration lower than bowing.

If turning the bed toward the qiblah is impossible, or moving it harms the patient or the medical devices, he prays toward the direction he is facing and does not delay the prayer beyond its time.

What remains obligatory when the form of prayer changes?

The concession regarding standing, bowing, or prostration does not drop the rest of the prayer. The sick person still performs the opening takbir, recitation of al-Fatihah, the takbirs, tashahhud, salam, the remembrances of bowing and prostration, and stillness, all according to his ability. If he is unable to speak, he does what he is able to do, what he cannot say falls from him, and he intends in his heart the actions and transitions of the prayer.

How does the sick person estimate his ability?

Ability differs from one person to another, and it may differ for the same sick person from one prayer to another. What matters is the real ability at the time of prayer, not merely the medical diagnosis and not the desire to take the easier option.

It is permissible to rely on the statement of a trustworthy specialist doctor if he determines that a certain posture increases the illness, delays recovery, or exposes the patient to falling or harm. If the sick person is unsure, he tries what he can safely without exposing himself to harm, and he seeks help from those around him.

The sick person's purification for prayer

The default is that the sick person performs wudu with water if he is able to use it without harm, and he may seek help from someone who performs wudu for him. If some of his limbs are sound and others are injured, he washes what is sound and deals with the injured limb according to the ruling of a bandage, wiping, or tayammum according to his situation.

Allah says:

{O you who believe, when you rise for prayer, wash your faces and your hands up to the elbows, wipe over your heads, and wash your feet up to the ankles. If you are in a state of janabah, then purify yourselves. But if you are ill, or on a journey, or one of you comes from relieving himself, or you have touched women and do not find water, then perform tayammum with clean earth and wipe your faces and hands with it. Allah does not intend to place hardship upon you, but He intends to purify you and complete His favor upon you so that you may be grateful.} [al-Ma'idah: 6].

If using water harms him, or he is unable to reach it and finds no one to help him, he performs tayammum with clean earth. Clean soil may be brought to him in a container or clean bag for him to use when needed.

If he is unable to perform both wudu and tayammum, and finds no one to help him, he prays in the time according to his condition and does not leave prayer. He removes impurity from his body, clothing, and place according to his ability. If he is unable to remove it, he prays according to his condition.

Urinary incontinence, catheters, and medical diapers

Whoever has urinary incontinence or continuous discharge from either private part, and likewise the woman with irregular bleeding, if the discharge stops for a time long enough for purification and prayer, he prays during the time of stoppage whenever that is possible within the prayer time. If it is continuous and does not stop for enough time, he protects himself from the discharge, cleans the area as much as he is able, then performs wudu after the prayer time enters according to the majority of scholars, and prays. The continuation of the discharge after that does not harm him. If using water harms him, he moves to tayammum.

As for the presence of a catheter, urine bag, tubes, or medical devices, these do not by themselves prevent prayer. He empties the bag and removes impurity if possible without hardship or harm. If that is not possible, he prays according to his condition. Some details of purification may differ according to whether the discharge is continuous or intermittent, so the specific case should be asked about when needed.

Facing the qiblah in the hospital

The sick person must face the qiblah according to his ability. If his chair or bed can be turned safely, he does that, and he may ask his family or care team for help.

If he cannot be turned because of the heaviness of the bed, fixed medical devices, fear of harm, or not having anyone to help him, he prays toward the direction he is able to face, and his prayer is valid, Allah willing, because he performed what he was able to perform.

May the sick person combine prayers?

The default is that each prayer is performed in its time. However, if the sick person experiences clear hardship by performing each prayer in its own time, then according to a large group of scholars he may combine Zuhr with Asr, and Maghrib with Isha, either by bringing the later prayer forward or delaying the earlier prayer, according to what is easier for him.

Ibn Abbas, may Allah be pleased with them both, said:

"The Messenger of Allah, peace and blessings be upon him, combined Zuhr and Asr, and Maghrib and Isha in Madinah, without fear and without rain."

In another narration, when Ibn Abbas, may Allah be pleased with them both, was asked about the reason for that, he said:

"He wanted not to cause hardship for his ummah."

Narrated by Muslim.

Combining is done as follows:

1. Zuhr is four rak'ahs and Asr is four rak'ahs for the sick person who is not traveling.
2. Maghrib is three rak'ahs and Isha is four rak'ahs for the sick person who is not traveling.
3. Fajr is not combined with any other prayer, and Asr is not combined with Maghrib.
4. The sick person does not shorten the prayer merely because of illness; shortening is specific to travel. If the sick person is traveling, then the rulings of travel apply to him.

Combining should not be made a habit when there is no hardship. Rather, he prays each prayer in its time whenever he is able.

Prayer before and after surgery

If the prayer time enters before the operation, the patient prays before it according to his ability. If he is able to combine because of illness or the length of the procedure, he combines Zuhr and Asr, or Maghrib and Isha, in the time of one of them.

An obligatory prayer is not prayed before its time enters. If anesthesia will last a long time, he asks the doctor about the expected duration and arranges his prayer within the legislated time as much as possible. As for what he misses while unconscious because of anesthesia, the ruling on making it up has details among the scholars according to the length of unconsciousness and the person's condition. He should ask a trustworthy scholar after waking, and he should not leave the matter without asking.

Friday prayer and congregational prayer for the sick person

If going to the mosque causes the sick person clear hardship, or he fears that the illness will worsen, he may fall, or he may transmit harmful infection, then he is excused from Friday prayer and congregational prayer. He prays Zuhr in his home or hospital as four rak'ahs instead of Friday prayer.

As for a slight illness that does not make attending congregation difficult, it should not be made a permanent excuse for leaving it. The sick person should observe instructions that prevent infection and protect worshipers from harm.

The sick person must not delay prayer waiting for recovery

It is not permissible for the sick person to leave prayer until its time exits because he cannot perform normal wudu, stand, or prostrate. Rather, he purifies himself and prays according to his ability within the time.

The concession is not a deficiency in the sick person's worship. Rather, it is Allah's ruling for him. The Prophet, peace and blessings be upon him, said:

"When a servant becomes ill or travels, there is written for him the like of what he used to do while resident and healthy."

Narrated by al-Bukhari.

Whoever was consistent upon worship and then illness prevented him, it is hoped that he will receive the reward of the good he used to do, along with the reward of his patience and obedience.

Common mistakes in the prayer of the sick person

1. Leaving prayer during days of illness with the excuse of making it up after recovery.
2. Praying sitting while able to stand without harm or severe hardship.
3. Leaving all standing while able to stand for part of the prayer.
4. Leaving prostration on the ground while able to do it merely because of using a chair.
5. Making bowing and prostration gestures equal, while the correct way is for prostration to be lower.
6. Raising a pillow or table to the forehead instead of gesturing when unable to prostrate.
7. Shortening the prayer to two rak'ahs merely because of illness, while shortening is for the traveler.
8. Combining prayers without recognized hardship.
9. Leaving prayer because of inability to perform wudu, while tayammum is prescribed, or prayer according to one's condition when completely unable.
10. Exposing oneself to falling or harm even though the Sharia permits praying sitting or lying down.