Posted By Fred Pratley
Stuart,

The only experience I have had of "fasting" arose when we had an employee report to our company nurse as feeling rather unwell. She could not make agreat deal of sense of his "feeling faint, dizziness" etc. She had him rest on a bed for about 30 minutes, and although pale, he said he was well enough to carry on working. nett result is he then got up a bit quick and immediately fainted into her arms. Had he got a couple of steps outside the First aid post, he would have fainted onto the concrete floor of the factory.

On close questioning, it was discovered that through a variety of pressures, including new child (born early morning the previous day), getting various relatives to see new child and wife in the hospital (Yes he should have taken time off, but elected not to), he basically have nothing but coffee to eat or drink for 36 hours.

True, he was of slim build and had few body reserves as such.

What your colleague is suggesting is unacceptable - even for 7 days.

Depending of what he does for a living, he might place other at risk, though lack of concentration on what he is doing.

I would suggest getting medical opinion on this as I feel that he would be making himself delibrately unfit for work.

regards Fred

Posted By Andy Petrie
you just have to look at what happened to david blane last year when he did his 'in the box' thing. He was resting and his body nearly geave up, it would be impossible to do this while working at the same time.

The best bet is to recommend what muslims do during Ramadan and fast during daylight hours and eat during the evening, even then he will need a risk assessment of his tasks to ensure that there will be no danger to himself or others.

Posted By Bill Fisher
Stuart

Can't say anything against what already has been sais, however I would add.

Set aside the person's (religious) reasons and what difference is there to any of the various (faddy) diets on the go for many years. I add in "faddy" to distinguish from a structured diet by Weigh[expletive deleted]chers or similar. The fact is that the only difference is you have been told about it.

Do you have a company doctor or nurse who could support both sides during this proposed period?

As for HR issues I would pass them to the appropriate manager with your advice/opinion and let them manage the person.

Regards
Bill

Posted By Kieran J Duignan
As the 'competent' person appointed to advise on safety in your company, in my view, on the basis of the facts as you state them, you have a duty to both employer and employee to
a. make a clear assessment of the risks to which the employee would expose himself by fasting for 40 days, and
b. indicate as clearly as you can what reasonable actions you can arrange to manage the risks you have identified.
c. remind the employee that he shares legal responsibility for managing risks to his health and safety.
d. ask senior management to consider arranging an assessment of the employee's psychological fitness to work, by a chartered occupational psychologist which is also qualified as a psychiatric nurse or as a chartered safety and health practitioner.

If your organisation employes a H R professional, he/she has a parallel responsibility to advise you, the employee and senior management about the provisions of the Employment Equality (Religion or Belief) Regulations 2003 in this instance. The employer's responsibility under these Regs is to avoid 'unfavourable treatment' on grounds of religion or belief, which means direct discrimination, indirect discrimination, victimisation or harassment.

These Regulations don't explicitly state whether, as in the case of disability discrimination, health/safety provisions supercede those of the EERB Regulations; accordingly, it is the responsibility of senior management to make a policy decision, with the advice of HR (if there is such a function in your place). One option, in a case like this, is to consider unpaid leave of absence, with an arrangement for checking that the employee doesn't simply go awol.

Should the employee challenge an explicit statement of management on grounds of religion or belief, you then enter uncharted legal territory for, to my knowledge, there has been only case of litigation in the UK on the grounds of the EERB Regs. He would have to establish the basis on which his religious belief warrants a fast which reduces his availability to work safely and to persuade a tribunal that it is reasonable to expect any employee to behave in a comparable manner.

If he did turn up with sufficient energy to present himself to a tribunal to argue a sound case. he would inevitably face cross-examination on whether he had also chosen the time of the tribunal hearing to fast - and, if not, the reasons for his timing of his fast. Unless there were a robust reply, counsel fot the employer could resaonbly argue that he had effectively frustrated his contract by not making himself available for work and could be fairly dismissed in accordance with the Eemployment Rights Act 1996.

Unless, of course, before matters got to that stage, the tribunal had not decided to refer him for a psychiatric assessment.

Posted By Robert Tailby
As a "born again" Christian myself, my first response to your friend would be to ask if he has talked the proposed fast over with people at his church, such as the Pastor or one of the Elders.

If I were the Pastor in question, I would want to talk through with your friend some of the practical aspects of fasting (what to eat before and after, when is a good time etc), and also explore with him his motivation and expectation of fasting. I would probably refer him to a couple of good books on fasting, such as "Celebration of Discipline" by Richard Foster, and "Hunger for God" by John Piper. I would probably suggest that a 40 day fast is something to work up to, rather then go for straighat away, and such lenghty fasts are usually only undertaken by people with lots of experience of fasting and who have set time aside in their lives specifically for this purpose. I would also refer him to verses in the Bible that talk about fasting being something that we do in secret, and in a way that means other people have no idea we are doing it, and also to verses that talk about our responsibility to serve our employer faithfully and well at all times.

I hope this is a helpful perspective.

Robert

Posted By Jim Walker
Nice response Robert.

As a born again Christian - what are you feelings about the folks who
responded that some psychiatric assesment is required?

Just as a matter of interest (I'm not planning to try it you understand) is it physically possible to survive on water for 40 days?

Posted By J Knight
According to wikipedia the republican hunger strkers in 1981 survived for an average of ten weeks on just water and salt, normally it's a lot shorter than that though, especially if the person involved wants to move about at ll,

John

Posted By stuart gorringe
Thanks for all responses to date, with regards to getting a medical opinion I have asked my colleague to complete a permission note to allow us to approach his doctor for his assessment on him completing a 40 day fast. However I must add that he has not completed this slip as yet. During our last discussion he was weary of his doctor being helpful.

This is a genuine 'nil by mouth' (except water, although he has told me he will add a little lemon juice to it) situation, he has completed a couple of fasts prior to this (this is the first brought to my attention), but this will be his longest. The environment that he works in involves fast moving tow and machinery with entanglement & entrapment being the major risks. FLTs, slips 'n'trips, use of knives & scissors also feature

I have raised the issue of monitoring during the fast by our occ health service provider but the individual is reluctant to have this. We have also considered unpaid leave and this will remain in the final assessment. Given the shift pattern it is possible for him to complete at least the first 25 days without us knowing. I have asked if a member of his religious group would be willing to give us any advice but unfortunately no one can. Robert (thanks for the books), I have checked the mcb.org.uk website, although they have no fact sheets on this I can indeed post a question there also. This issue is also being discussed by our HR colleagues and any information of note I will bring to the table. With regard to doing a fast in secret my colleague feels duty bound to inform me of his fast due to his responsibility to serve his employer faithfully and well at all times. Indeed, he has also said that he would stop a fast if it affected his ability to work.

Still have a whole host of reading to do to get to grips with this one, my colleague states that when he gets the calling for the fast he will prepare his body and mind. I have talked some of the issues through with his immediate manager with regard to managing this, but based on what I currently know, feel that from an assessment point of view I would not be able to recommend supporting a full 40 day fast whilst carrying out normal duties. With or without a psychaitric assessment

Thanks once again for the information to date, please keep it coming.

Stuart

Posted By Jonathan Breeze
John,

From a purely H&S perspective, you are of course right.

However, there are many other issues here, including the fact that the employee has given advanced notice and stated religious reasons for the fast.

This surely adds a whole new dimension to the issue, which pure H&S is not equipped to address.

Posted By Robert Neil
Experience during Ramadan in Muslin country of increased occurances of Fuel Tanker roll-overs. CInvestigation linked this to daily fasting/work times/eating times issues. Recommendations on eating times & work times within the fasting rules solved the problem.

Conclusion - On a daily fast for a worker on critical duties, adjustment of eating and working hours makes a big difference to the safety outcome. As a fast gets longer, the safety implications will be greater..

Robert

Posted By Dr. Andrew Rankine
I've only just come across this thread, so I hope I'm not too late to contribute. The comments about getting competent advice are well made, and I would echo them. Universities nowadays can have many Muslim students who are well supported during Ramadan: perhaps a university-based imam could advise on that aspect of fasting.
I routinely fast for one or two days without any real preparation and I haven't noticed any significant drop off in my concentration or motor skills. Books such as "The Complete Idiot's Guide to Fasting" suggest that Ramadan style fasting is possible provided one is commited enough, but that anything like seven days or longer with no food at all should be worked towards. Rule of thumb: medical students are taught that the human body can survive three minutes without oxygen; three days without water, and three weeks without food (obviously with great individual variation)
Forty days without food is, in my view, too long to be contemplated by anybody trying to do a normal job of work. Buddhist and Hindu ascetics will go on long fasts as part of deep meditation involving no physical effort. I would defer to my Christian friends here, but I imagine that when Jesus spent 40 days fasting, he too would have been keeping movement to a minimum.
In safety management terms, therefore, this is not permissible. In my limited professional experience, while one doesn't like to expressly forbid an activity, long fasts fall under the same category as the art student who, for his final year project, proposed to have himself crucified. No, really. I believe he was talked out of it. I think that your colleague, Stuart, should be calmly talked out of trying too hard too soon.

Posted By Dr. Andrew Rankine
I've just noticed a report on the re-feeding of illusionist David Blaine after his 44 day fast in last week's New England Journal of Medicine, 2005, 353, p2306-7. When he finally came down from his glass box, he had lost a quarter of his body weight, so he was admitted to hospital for observation, tests, and controlled refeeding. The tests showed that at the end of his fast he was dehydrated, deficient in vitamins B-1 and B-6, and a little low on potassium. His carbohydrate metabolism had survived unscathed, but he had a high serum concentration of free fatty acids and a very high serum concentration of hydroxybutarate. His liver function was slightly abnormal. Doctors were most worried, however, by his serum concentration of phosphate, which was low on admission and fell even lower during the first 24 hours of refeeding. He needed an intravenous infusion of phosphate over the first night. Hypophosphataemia is a well known consequence of refeeding. So is oedema, which had occurred by day 10, despite restricting his salt intake. Blaine apparently did not get hungry until three days after the end of his fast. Then he became very hungry! And all this in a man doing no physical work.

Posted By TBC
Agree with you Colin - when I was a young firefighter and late for work one day and I missed breakfast. We had a very busy morning with calls and drills. Just before lunch I felt really faint and was sent home. Why? I was a danger to myself and the others around. I don't miss breakfast any more no matter how late I may be.

Regards

Posted By stuart gorringe
Thanks for the continued comments in this thread, the aim is to complete a fair and reasonable assessment based on the information that we have.

To add to this discussion, if we replace the word fasting with hunger strike and then look at the effects on the body it throws up some interesting facts.

Health Effects of Hunger Strikes
Depending on the length of a hunger strike a person can do severe, in some cases irreparable, damage to their body. The following is a short list of the serious health risks involved in carrying a hunger strike beyond 2-3 weeks -- this info assumes that you are engaging in a water-only hunger strike and you are basically healthy when you begin your hunger strike, also some of these effects are not permanent:
•Damage to muscle tissue (after ca 4 weeks)
•Weakening of bones (after ca 4 weeks)
•Hallucinations / Dementia (after ca 3 weeks)
•Potentially permanent brain damage (after ca 4 to 5 weeks)
•Potentially permanent damage to internal organs (after ca 4 to 5 weeks)
•Potential failure of internal organs (after ca 4 to 5 weeks)
•Death (could happen at any time depending on the state of your health)

Potential Drawbacks for hunger strikers: Hunger, Weakness, Backaches, Bad Breath, Cankers , Colds and other viruses, Blackouts , Diarrhea , Headaches , Muscle Tightness , Nausea , Nervousness , Skin Disturbances , Tiredness , Feeling Cold, Insomnia, Abdominal pains , Depression, Constipation and Nightmares

Major Risks:
After Week 3, or whenever weight loss exceeds 18 percent of the starting weight. The body tries to compensate by slowing down its metabolism, entering "starvation mode." Still, once fat stores are entirely depleted, the body has no choice but to mine the muscles and vital organs for energy. The striker simply wastes away as his body, quite literally, consumes itself. There are major risks to fasting, including death.
•Dehydration is a risk in voluntary total fasting, as individuals may lose their feelings of thirst and hunger.
•Clinical Depression One study showed 77% of hunger strikers to be clinically depressed at the time of admission to hospital, measured by an independent psychiatrist, although they also demonstrated features similar to those of the post-traumatic stress syndrome.
•Cardiac Failure from loss of cardiac muscle.
•Ketoacidosis. Fasting becomes dangerous after just three to five days, at which point the body begins breaking down fat in order to produce energy. When the liver is reduced to breaking down fat (in lieu of the usual glucose), it produces ketone bodies, a toxic byproduct. These can be excreted through the urine, and a particular variety known as acetone can be expelled through the lungs. (Acetone makes a person's breath smell like pears.) Ketone bodies can also be oxidized by the brain in order to make the fuel it needs. But when ketone bodies become too numerous in the bloodstream, they can cause this potentially lethal condition that afflicts some diabetics.

Safety Tips
•Don't fast if you have health problems, especially an infection, advanced cancer, a compromised immune system, diabetes, ulcers, liver, kidney, heart, or lung disease, epilepsy, arthritis, schizophrenia, severe asthma, hypoglycemia or other serious illnesses.
•Conclusions from studies recommend independent medical monitoring after a weight loss of 10% in lean healthy individuals.If the pre-hunger strike weight is unknown, a maximum of 10 days' hunger strike, or a body mass index of less than 16.5 kg/m, should be the trigger. Major problems arise at a weight loss of about 18%.
•Anyone who takes prescription or recreational drugs regularly should not fast without medical supervision. Withdrawal symptoms can develop quickly during fasting.
•In order to lessen the shock to your body, drink lost of juice and eat mostly raw fruits and vegetables the week before the fast… so that the detoxification during water fasting will be less aggressive.
•You also need to mentally prepare.
•If you decide to go on a hunger strike, don't eat anything. A little food just makes you stay hungry and protein-only fasting is dangerous.
•Drink two liters of fluids every day, supplemented with one-quarter to one-half teaspoon of salt if possible.
•Stay warm and avoid unnecessary physical exertion.
•If you feel sick after three or four days, insist on seeing a doctor immediately (safety and strategy tip)

All in all it makes an interesting case given the other issues that it may throw up. I think once we have drawn all information provided into a reasonable assessment the length of fast that we as a company could allow with our current knowledge would be quite short in duration.

Further thoughts welcome, Stuart