I could tell you,
But you’d laugh at me.
Because it is bare, raw and pure.
You gloat on the preservatives.
You discard the genuine.
Listen to me, my friend, there is a part of the world, where even a bulb is never, ever, witnessed in real, but reel of the sanskrit Cartoon slots. The peppy  and ‘lone B-grade Cartoons .
Filled with Flesh.
The stories of tantric mantras, with a sliver of diminishing hearth,
on the
Dimensions and depth of the Yoni in the resin of shellac
on the Immaculate ceremony,
In a woodpecker hole just underneath the sealed power of the Yakshini who truly screws it up if you have taste of her once.
the one who harbingers drunk loners of Kavadiyattom alley after 3:20 am.
She takes them to the crown chakra of palm trees.
Shows them the world.
she pushes them off the crown and the falcon falls in endless spirals of a inhuman push that pushes the concrete innards to a danlgling mass of amoebic copulation.
Breath comes back.
It is a big nauseating gag of Kumbhakarnan's long sadya that lasted for half a decade.
Of the soma saras that made the entire India go, ga-ga and believe they've seen the god.
But not one nor any saw the same face, colour, shape or even vibe of the god they had seen alone.
They agreed in unison that all their hallucinations of beautiful humans in Flower UFO s and high-tech cloning, were a vital hair in the nostril of the cosmos.
They made, each a god out of their genuine mix of memories.
Or in the, priest's ways,
Hence, the 2.3 Billion populous of the country had the same, well, odd Spiritual benefactors.

Keeping it all aside, lemme be honest, I'd follow many a fairy god-mother but give my milkey teeny tooth to the special one.
Hinduism tells you God is omnipresent.
Hinduism tells you God is within you.
It also says, there is no God.
The clipper to snap off the confusion of this, lies in the same cheap stained-yellow cliche of love. It entails everything. You, me, animals, plants, cosmos, vibes, thoughts, dreams and the universe.
It tells you to live with your body mind and soul.
From Kamasutras that teaches sense.
The excitement, control and breakthrough of it.
Like tao did under his exposed roof without the sacred dung of from Hindu Land.
This is the secret of a rumoured Mohini,
Of her 1000 per hour ******* during the her/ his/ its 352 incarnations.
which was the reason for Big bang.  
Amidst the sultry scant of the voluptuous *******,
Their skin,
a vernacular reflection of a dusk on the Japanese gold beaches, And the mounts,
firm and glowing with the rusty shade of pharaoh’s Gold anklet.
The gooey glaze of yesterday’s glamour in the wink of a gay galore.
Paulo Ceolho’s Holy Communion with God,
Or like the Japanese Tengaman says,
Or rather screams,
That all it it takes is a little *******.
So, yes.
That precise art of attaining a consciousness, from where your mind was
Afloat
Wild
Free
Satiated
By yourself
You’ve just consumed the essence of you
Your Ojhas
And the tiny matter that teaches the universe
Of a Shunya.
That, momentary sense of lapse of your body mass,
Or the breakthrough into your eye of the crown.
Only to join the mundane bustle of the 10,00 speakers on all four
JBLs, Boses and Pioneers live looping the zillions of sanskrit mantras under one roof.
In your Ear drum.
A synechdoche of the Gods and their jacuzzi of amphetamine bubbles.
Splashed from a white Elephant's bejewelled Snout, which has the
crowned ring in your pineals.
Secret lies under
the rotten bone chip of Hussain Sagar
deep under the ***** green lake,  
drowning the rainbow Buddha in the city of slimy immortal maggots on ham.
Open your eyes.
For the Gods will
Else
Cut your eyelids off
to show you that
the city's shardminds await you.
roaring
Playing close to the fire demons of Redland
A nail close to your wide open lid-less
White flowing eye.
Hear the city scream.
The deafening chaos,
In unison,
Intoxicating their venomous fruits
of the delirious worlds
Or simply put, divine prayer and offering
for
the Omnipotent,
Omniscient
And the
Om.
Shunya.
Or the cyclic abyss of meaninglessness.
But,
Like, the wilted azures
that seduced those flies,
From a far far away,
To come the praise the combs of their bellies,
Filled with the red from the omnipotent, dead, weak and evil
In one little fly belly.
They came from the
land called Lullaby.
To go there
from here,
But, first,
bear the Weasleys' infamous extendable ears and heed me now, for I say twice and See him Come.
The snake, the tangy smell of goated black rub and blueness.
Siva shouldn't come?
Not yet. A little DMT more in the brain and perhaps the spark will happen.
Better than the potions of those gigantic forest priests.
No, Heed me, now.

3 Dodos Walk-afar,
And, take the lone left-laden log
the one that is,
limitless Long
loyal and  let alone
By those
languors which
Killed
Lord Leopard Loot'.
While,
Lord's Lass
Lays lolled lambs,
Lolled ‘long le ******,
Leech on the laiden log,
leading to Lord Lava,
Yes.
The bridge of Casilii Po.

Of the Lord.
Guarded
By these bubbling bellies with a drop of the world's make.
Assassins.
the Fly, flies.

retain the scarification of theolden curse,
Older than the rocks underneath this gurgling lava,
On which reincarnation steams.

As destiny should have it,
the astrologers had seen,
3 centuries back
That at a Sphinx’s Wedding,
a war of Vision,
will break.
It will
Bring the Stars
Out of those melting blue nightsky of Neruda's wails;
And the diabolic estrangement inflicting Eagle,
From Meena’s vibes,
that rubbed of a distinct scent of Malabar embedding a little of everybody in the village,
on its Kasavu lines posing
at the focus
of Sahib's Ferguson or Baker.

The gold turned white.
A liquid white, like that of the sap,
For that,
***** on a parrot green rubber plant
And work your fun with the white gluey milk,
fragrant than the sap
Like the  Ylang Ylang buds freshly kissed by the drooly dew,
sealed away
elegantly in a crystal Indigo bottle by the pen stand.

One that glitters if you look at its surface, but smells of naphthalene ***** in the sink
in
that
creepy trailer in
mid salem night of the tut.
Colourful.
This is colorblind.

White is motile.
White is wriggling.
White is life.
With a **** of Eve’s fabric-less
Skin.
White is divinity
feeding you excess of everything,
With an tenfold over dosage injected intravenous, by a silver-haired-glow-in-the-dark-dodo-cupid;

She is divine.
**** Her.
**** her on a Pyre.
**** her innards on a fire.
inflame the bubble
of her her oily effluent you found on the toilet seat
Instil in her, the seed of your sodomic occult,
Not by compassion, but through a hiss and sting
of the
flawless venom of the diabolic.  
Then. Disinfect your fruit that you flicked off the paradise.
And bellow to the blowing gurgling below.  
A reign of ****  nihilism,
moaning the mood-swings-of-a-98-year-old-menopausing-Bhairavi of the Indian Aghora Tales;
And Shelly, fueled in his undiminished hearth with the help of his impetous West Wind,
dreaming lucid,
on a flight in the sky for one week,
with Lucy’s sewing  sequined buttocks,
Stinging their luminescent, lactating, lustrous skin,
Like a tatto machine, lifting rays into the epidermis
So that it roasts, burns a soot and neonifies the only colour
A shade of
The rave, rainbow-red karmas of human existence,
Its little greedy quantas waltzing around the matter
And of its unleashed illuminations
That fuel the same vessel in the universe,
infamously known as,
the
black hole.
Uggh!!

I thought it right to assess some antidepressants, which philosophers are more inclined to call mood enhancers.
This was during my foray into human enhancement, substances intended to enhance physicality, cognition or mood. Nootropic compounds concern the latter two categories.

The most commonly prescribed mood enhancers are serotonin reuptake inhibitors (SRIs), but it takes over a week for these compounds reach their peak effect.
Thus I approached them with the notion that a limited dosage might point to their character, though  not reveal. These considerations in mind, I set about acquiring a few miscellaneous anti-D's.

Fluoxetine was the first successful selective serotonin re-uptake inhibitor (SSRI), better known by its original brand-name Prozac. Fluoxetine has an acute biological half-life of between 1-3 days. Presence of a trifluoromethyl group on the compound deserves note, I wonder what the presence of electronegative fluorine atoms add to the psychoactive flavor of a compound (subjective effects).
I administered a single dose by mouth, there was some indication of subjective character. Light serotonergic sensations and seemingly benign mood-dampening, there is a ****** towards the positive. Waking headspace relatively uninteresting. Observed hints of oneirogenesis, did not manifest in enough character to be detailed - a sort of vivid, 'pulsive wandering, more pronounced in contrast to its waking character.
Good experiment, interesting results.
Ligand     Ki (nM)   Ki (nM)
Target      Flx            Nflx
SERT        1               19
NET         660           2700
DAT         4180         420
5-HT2A   200           300
5-HT2B    5000         5100
5-HT2C    72.6          91.2
α1             3000         3900
M1            870           1200
M2            2700         4600
M3            1000         760
M4            2900         2600
M5            2700         2200
H1            3250         10000

Sertraline is another popular SSRI, also known by it's original brand-name Zoloft. Sertraline has a variable half-life, on average 26 hours.
It's metabolite, desmethylsertraline, has a half life between 62-104 hours but is a far less potent Serotonin Releasing Agent (SRA).
The presence of two chlorine atoms is interesting. The usual, phenomenal serotonergicity is present and pushing towards the positive.
Some nausea, particularly when hungry (this disappeared after some minestrone soup). Some faintness after physical exertion. This dose did not promote onirogenesis. There was a moment of cognitive distortion when the proportions of a focal object seemed to be growing in-and-out, shifting in size.
Site                 Ki (nM)
SERT              0.15–3.3
NET               420–925
DAT               22–315
5-HT1A       >35,000
5-HT2A          2,207
5-HT2C          2,298
α1A        ­        1900
α1B                 3,500
α1D                 2,500
α2                  477–4,100
D2                  10,700
H1                  24,000
mACh           427–2,100
σ1                   32–57
σ2                   5,297

Escitalopram is an SSRI commonly prescribed for major depression and generalised anxiety. It is the (S)-stereoisomer of citalopram. The biological half-life is of escitalopram is between 27-32 hours.
I administered a dose and thought the phenomenal serotonergicity less apparent than fluoxetine but then gastro-intestinal disturbance was noted, I surmised it has a high affinity for 5-HT2C.
Any oneiric qualities were not readily apparent after a single dose, relatively little visual imagery which is understandable given its lack of affinity for 5-HT2A. I found this to be philosophically interesting. Mood elevation observed in bursts of conversation and as odd sensations, possible mental discomfort.
Ligand,
Recptr     Ki (nM)
SERT       2.5
NET        6,514
5-HT2C   2,531
α1            3,870
M1           1,242
H1           1,973

Venlafaxine is a selective serotonin-norepinephrine reuptake inhibitor (SNRI). Venlafaxine and its metabolites are active for about 11 hours.
Initial subjective effects similar to a very light empathogenic stimulant. Perception of altered attention-span/increased reflexive response; energizing yet paradoxically much yawning.
Ligand,  Vnfx      Dvnfx
Recptr    Ki(nM)  Ki(nM)
SERT  ­    82           40.2
NET       2480        558.4

Tianeptine is a tricyclic antidepressant (TCA) with an unusual mechanism of action. It is an atypical agonist of the μ-opioid receptor and has been described as a (selective) serotonin reuptake enhancer (SRE). It has a short duration as sodium salts [prescribed form] of between 2-4 hours but as sulfate this can be notably extended, some of its metabolites are active for longer than tianeptine itself.
Definitely anxiolytic, quite artificial; possible aphrodisiac. I find its opioid activity dissuading, requires caution.
Site          Ki (nM)
MOR       383–768 (Ki)
                 194 (EC50)
DOR      >10,000 (Ki)
                 37,400 (EC50)
KOR      >10,000 (Ki)
                 100,000 (EC50)
All other transporter/receptor/sub-receptor values are >10,000 (Ki).

Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) with affinity for some nicotinic receptors. Bupropion and its metabolites are active for between 12-36 hours. Interestingly it is a substituted cathinone.
Initial subjective effects similar to a fairly light stimulant. Perception of increased attention-span and improved cognition. It is an onirogen that is neutral in quality, enhancing vivid dreaming (a boon of its nicotinic affinity which is counteracted if the stimulant component impinges on sleep). Completely absent of serotonergicity, curious.
The N-tert-butyl group's effect is most interesting, how it affects metabolism and to what extent ROAs alter pharmacokinetics.
I took 150mg ******, as extended and as instant release (the latter was more pronounced). I thought an altered pharmakinetic profile might result from bypass of hepatic metabolism, so I tried 25mg insufflated and felt as if there was effect that it differed slightly from oral ROAs, but also worried that its metabolic fate is thence unknown (compare to the neurotoxic 3-CMC). What of other bupropiologues,
for example, 3-Methyl-N-tert-butyl-methcathinone? Indeed.
                        Bupropion    R,R-Hydroxybuprpn   Threo-hydrobuprpn
AUC               1                     23.8                                  11.2
Half-life         11 h                 19 h                                 31 h
IC50 (μM)
DAT               0.66                  inactive                          47 (rat)
NET               1.85                   9.9                                  16 (rat)
SERT              inactive          inactive               ­            67 (rat)
α3β4 nic         1.8                   6.5                                   14 (rat)
α4β2 nic         12                     31                                   no data
α1β1γδ nic     7.9                    7.6                                  no data

Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA), its monoamine oxidase inhibition lasts about 8–10 hours and wears off completely by 24 hours. Inhibiting the decomposition of monoamines (e.g. serotonin, norepinephrine and dopamine) increases their accumulation at an extracellular level. It tends to suppress REM sleep and so it lacks oneirogenic properties.
Feeling of well-being, less constrained by the usual anxieties; openness. Relatively unnoticeable side-effects when diet is carefully managed. Made the mistake of eating a cheese and turkey sandwich (i.e. foodstuff rich in tryptophan/tyramine), indications of serotonergicity later became apparent: feelings of overheating and flushing, slight sweating, racing thoughts and anxious discomfort. A stark reminder of Shulgin's old adage: "there is no casual experiment".
Combination with a select few tryptamines (not 5-MeO-xxT) should be safe, and synergistic (perfect for pharmahuasca); reputed to potentiate GHB. However, generally it is extremely dangerous to combine with serotonergic drugs.

My heart bleeds blue at midnight. I heard owls hooting in my despair. Alone ,I lay naked underneath the beaming moonlight. I touch slowly my neck and close my eyes. Thinking of a predator I been waiting for a lifetime slowly slithering its warmth on my thighs.So preciously antagonizing my soul with its piercing eyes.It's breath is an intimidating musical hiss. I crave it's injection. Hiss between every piercing kiss.I touched myself harder as the owls hooted into the moonlight. I needed you. Imagining my predator teasing my heated skin with its cold fangs. Immensely waiting for its long hollow teeth to pierce me. While wishing, it instantly became the predator of my heart as it slither around my skin.The music began to start.Predator started to taunt, looking for the sweetest fatal bite.My soul began gasping harder, My predator, oh please prey on me harder.Slither uncontrollably, slither harder as my breaths change heavily. Predator inject itself slowly through every bite.Oh I am in love.It was perfect dosage. This is love. Intoxicating every blood vessel of my body.Every bite,I felt more yours. I instantly became weaker, your bite was the perfect dosage for the ****. It was perfect dosage.The perfect poison. This was love. The perfect *******. Underneath the moonlight , vivaciously sweating naked I screamed. Longing more for your touch.The owl hooted once more, morning has come.
I awake , I was loved for the first time.

With its injection ,
**The predator righteously own my crimson heart

HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to us e
M-M-R II safely and effectively. See full prescribing information
for M-M-R II.
M-M-R® II (Measles, Mumps, and Rubella Virus Vaccine Live)
Suspension for subcutaneous injection
Initial U.S. Approv al: 1978
-------------------------------INDICATIONS AND USAGE-------------------------------
M-M-R II is a vaccine indicated for active immunization for the
prevention of measles, mumps, and rubella in individuals 12 months of
age and older. (1)
-------------------------- DOSAGE AND ADMINISTRATION--------------------------
Administer a 0.5-mL dose of M-M-R II subcutaneously. (2.1)
• The first dose is administered at 12 to 15 months of age. (2.1)
• The second dose is administered at 4 to 6 years of age. (2.1)
------------------------DOSAGE FORMS AND STRENGTHS -----------------------
Suspension for injection (0.5-mL dose) supplied as a lyophilized
vaccine to be reconstituted using accompanying sterile diluent. (3)
---------------------------------- CONTRAINDICATIONS ----------------------------------
• Hypersensitivity to any componentof the vaccine. (4.1)
• Immunosuppression. (4.2)
• Moderate or severe febrile illness. (4.3)
• Active untreated tuberculosis. (4.4)
• Pregnancy. (4.5, 8.1)
-------------------------- WARNINGS AND PRECAUTIONS --------------------------
• Use caution when administering M-M-R II to individuals with a
history of febrile seizures. (5.1)
• Use caution when administering M-M-R II to individuals with
anaphylaxis or immediate hypersensitivity following egg ingestion.
(5.2)
• Use caution when administering M-M-R II to individuals with a
history of thrombocytopenia. (5.3)
• Immune Globulins (IG) and other blood products should not be
given concurrently with M-M-R II. (5.4, 7.2)
----------------------------------ADVERSE REACTIONS----------------------------------
See full prescribing information for adverse reactions occurring duri ng
clinical trialsor the post-marketing period. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Merck
Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., at 1-8 7 7 -
888-4231 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.
-----------------------------------DRUG INTERACTIONS----------------------------------
• Administration of immune globulins and other blood products
concurrently with M-M-R II vaccine may interfere with the
expected immune response. (7.2)
• M-M-R II vaccination may result in a temporary depression of
purified protein derivative (PPD) tuberculin skin sensitivity. (7.3)
-------------------------- USE IN SPECIFIC POPULATIONS--------------------------
• Pregnancy: Do not administer M-M-R II to females who are
pregnant. Pregnancy should be avoided for 1 month following
vaccination with M-M-R II. (4.5, 8.1, 17)
See 17 for PATIENT COUNSELING INFORMATION and FDA
approv ed patient labeling.
Rev ised: 06/2020
FULL PRESCRIBING INFORMATION: CONTENTS
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Dose and Schedule
2.2 Preparation andAdministration
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
4.1 Hypersensitivity
4.2 Immunosuppression
4.3 Moderate or Severe Febrile Illness
4.4 Active Untreated Tuberculosis
4.5 Pregnancy
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
5.2 Hypersensitivity to Eggs
5.3 Thrombocytopenia
5.4 Immune Globulins and Transfusions
6 ADVERSE REACTIONS
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
7.2 Immune Globulinsand Transfusions
7.3 Tuberculin Skin Testing
7.4 Use with Other Live Viral Vaccines
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.6 Persistence of Antibody Responses After Vaccination
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
14.1 Clinical Efficacy
14.2 Immunogenicity
15 REFERENCES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
Sections or subsections omitted from the full prescribing info rma tion
are not listed.
2
FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE
M-M-R® II is a vaccine indicated for active immunization for the prevention of measles, mumps, and
rubella in individuals 12 months of age and older.
2 DOSAGE AND ADMINISTRATION
For subcutaneous use only.
2.1 Dose and Schedule
Each 0.5 mL dose is administered subcutaneously.
The first dose is administered at 12 to 15 months of age. A second dose is administered at 4 to 6
years of age.
The second dose may be administered prior to 4 years of age, provided that there is a minimum
interval of one month between the doses of measles, mumps and rubella virus vaccine, live {1-2}.
Children who received an initial dose of measles, mumps and rubella vaccine prior to their first
birthday should receive additional doses of vaccine at 12-15 months of age and at 4-6 years of age to
complete the vaccination series [see Clinical Studies (14.2)].
For post-exposure prophylaxis for measles, administer a dose of M-M-R II vaccine within 72 hours
after exposure.
2.2 Preparation and Administration
Use a sterile syringe free of preservatives, antiseptics, and detergents for each injection and/or
reconstitution of the vaccine because these substances may inactivate the live virus vaccine. To
reconstitute, use only the diluent supplied with the vaccine since it is free of preservatives or other
antiviral substances which might inactivate the vaccine.
Withdraw the entire volume of the supplied diluent from its vial and inject into lyophilized vaccine vial.
Agitate to dissolve completely. Discard if the lyophilized vaccine cannot be dissolved.
Withdraw the entire volume of the reconstituted vaccine and inject subcutaneously into the outer
aspect of the upper arm (deltoid region) or into the higher anterolateral area of the thigh.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to
administration, whenever solution and container permit. Visually inspect the vaccine before and after
reconstitution prior to administration. Before reconstitution, the lyophilized vaccine is a light yellow
compact crystalline plug, when reconstituted, is a clear yellow liquid. Discard if particulate matter or
discoloration are observed in the reconstituted vaccine.
To minimize loss of potency, administer M-M-R II as soon as possible after reconstitution. If not used
immediately, the reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from
light, for up to 8 hours. Discard reconstituted vaccine if it is not used within 8 hours.
3 DOSAGE FORMS AND STRENGTHS
M-M-R II vaccine is a suspension for injection supplied as a single dose vial of lyophilized vaccine to
be reconstituted using the accompanying sterile diluent [see Dosage and Administration (2.2) and How
Supplied/Storage and Handling (16)]. A single dose after reconstitution is 0.5 mL.
4 CONTRAINDICATIONS
4.1 Hypersensitivity
Do not administer M-M-R II vaccine to individuals with a history of hypersensitivity to any component
of the vaccine (including gelatin) {3} or who have experienced a hypersensitivity reaction following
administration of a previous dose of M-M-R II vaccine or any other measles, mumps and rubellacontaining vaccine. Do not administer M-M-R II vaccine to individuals with a history of anaphylaxis to
neomycin [see Description (11)].
4.2 Immunosuppression
Do not administer M-M-R II vaccine to individuals who are immunodeficient or immunosuppressed due
to disease or medical therapy. Measles inclusion body encephalitis {4} (MIBE), pneumonitis {5} and death
as a direct consequence of disseminated measles vaccine virus infection have been reported in
3
immunocompromised individuals inadvertently vaccinated with measles-containing vaccine. In this
population, disseminated mumps and rubella vaccine virus infection have also been reported.
Do not administer M-M-R II to individuals with a family history of congenital or hereditary
immunodeficiency, until the immune competence of the potential vaccine recipient is demonstrated.
4.3 Moderate or Severe Febrile Illness
Do not administer M-M-R II vaccine to individuals with an active febrile illness with fever >101.3F
(>38.5C).
4.4 Active Untreated Tuberculosis
Do not administer M-M-R II vaccine to individuals with active untreated tuberculosis (TB).
4.5 Pregnancy
Do not administer M-M-R II to individuals who are pregnant or who are planning on becoming
pregnant within the next month [see Use in Specific Populations (8.1) and Patient Counseling Information
(17)].
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
There is a risk of fever and associated febrile seizure in the first 2 weeks following immunization with
M-M-R II vaccine. For children who have experienced a previous febrile seizure (from any cause) and
those with a family history of febrile seizures there is a small increase in risk of febrile seizure following
receipt of M-M-R II vaccine [see Adverse Reactions (6)].
5.2 Hypersensitivity to Eggs
Individuals with a history of anaphylactic, anaphylactoid, or other immediate reactions (e.g., hives,
swelling of the mouth and throat, difficulty breathing, hypotension, or shock) subsequent to egg ingestion
may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving M-M-R II vaccine
.The potential risks and known benefits should be evaluated before considering vaccination in these
individuals.
5.3 Thrombocytopenia
Transient thrombocytopenia has been reported within 4-6 weeks following vaccination with measles,
mumps and rubella vaccine. Carefully evaluate the potential risk and benefit of vaccination in children
with thrombocytopenia or in those who experienced thrombocytopenia after vaccination with a previous
dose of measles, mumps, and rubella vaccine {6-8} [see Adverse Reactions (6)].
5.4 Immune Globulins and Transfusions
Immune Globulins (IG) and other blood products should not be given concurrently with M-M-R II [see
Drug Interactions (7.2)]. These products may contain antibodies that interfere with vaccine virus
replication and decrease the expected immune response.
The ACIP has specific recommendations for intervals between administration of antibody containing
products and live virus vaccines.
6 ADVERSE REACTIONS
The following adverse reactions include those identified during clinical trials or reported during postapproval use of M-M-R II vaccine or its individual components.
Body as a Whole
Panniculitis; atypical measles; fever; syncope; headache; dizziness; malaise; irritability.
Cardiovascular System
Vasculitis.
Digestive System
Pancreatitis; diarrhea; vomiting; parotitis; nausea.
Hematologic and Lymphatic Systems
Thrombocytopenia; purpura; regional lymphadenopathy; leukocytosis.
Immune System
Anaphylaxis, anaphylactoid reactions, angioedema (including peripheral or ****** edema) and
bronchial spasm.
Musculoskeletal System
Arthritis; arthralgia; myalgia.
4
Nervous System
Encephalitis; encephalopathy; measles inclusion body encephalitis (MIBE) subacute sclerosing
panencephalitis (SSPE); Guillain-Barré Syndrome (GBS); acute disseminated encephalomyelitis (ADEM);
transverse myelitis; febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis;
polyneuropathy; ocular palsies; paresthesia.
Respiratory System
Pneumonia; pneumonitis; sore throat; cough; rhinitis.
Skin
Stevens-Johnson syndrome; acute hemorrhagic edema of infancy; Henoch-Schönlein purpura;
erythema multiforme; urticaria; rash; measles-like rash; pruritus; injection site reactions (pain, erythema,
swelling and vesiculation).
Special Senses — Ear
Nerve deafness; otitis media.
Special Senses — Eye
Retinitis; optic neuritis; papillitis; conjunctivitis.
Urogenital System
Epididymitis; orchitis.
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
M-M-R II vaccine should not be administered to individuals receiving immunosuppressive therapy,
including high dose corticosteroids. Vaccination with M-M-R II vaccine can result in disseminated disease
due to measles vaccine in individuals on immunosuppressive drugs [see Contraindications (4.2)].
7.2 Immune Globulinsand Transfusions
Administration of immune globulins and other blood products concurrently with M-M-R II vaccine may
interfere with the expected immune response {9-11} [see Warnings and Precautions (5.4)]. The ACIP has
specific recommendations for intervals between administration of antibody containing products and live
virus vaccines.
7.3 Tuberculin Skin Testing
It has been reported that live attenuated measles, mumps and rubella virus vaccines given individually
may result in a temporary depression of tuberculin skin sensitivity. Therefore, if a tuberculin skin test with
tuberculin purified protein derivative (PPD) is to be done, it should be administered before, simultaneously
with, or at least 4 to 6 weeks after vaccination with M-M-R II vaccine.
7.4 Use with Other Live Viral Vaccines
M-M-R II vaccine can be administered concurrently with other live viral vaccines. If not given
concurrently, M-M-R II vaccine should be given one month before or one month after administration of
other live viral vaccines to avoid potential for immune interference.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Risk Summary
M-M-R II vaccine is contraindicated for use in pregnant women because infection during pregnancy
with the wild-type viruses has been associated with maternal and fetal adverse outcomes.
Increased rates of spontaneous abortion, stillbirth, premature delivery and congenital defects have
been observed following infection with wild-type measles during pregnancy. {12,13} Wild-type mumps
infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.
Infection with wild-type rubella during pregnancy can lead to miscarriage or stillbirth. If rubella infection
occurs during the first trimester of pregnancy, it can result in severe congenital defects, Congenital
Rubella Syndrome (CRS). Congenital rubella syndrome in the infant includes but is not limited to eye
manifestations (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and
intellectual disabilities. M-M-R II vaccine contains live attenuated measles, mumps and rubella viruses. It
is not known whether M-M-R II vaccine can cause fetal harm when administered to pregnant woman.
There are no adequate and well-controlled studies of M-M-R II vaccine administration to pregnant
women.
5
All pregnancies have a risk of birth defect, loss or other adverse outcomes. In the US general
population, the estimated background risk of major birth defects and miscarriage in clinically recognized
pregnancies is 2% to 4% and 15% to 20%, respectively.
Available data suggest the rates of major birth defects and miscarriage in women who received
M-M-R II vaccine within 30 days prior to pregnancy or during pregnancy are consistent with estimated
background rates (see Data).
Data
Human Data
A cumulative assessment of post-marketing reports for M-M-R II vaccine from licensure 01 April 1978
through 31 December 2018, identified 796 reports of inadvertent administration of M-M-R II vaccine
occurring 30 days before or at any time during pregnancy with known pregnancy outcomes. Of the
prospectively followed pregnancies for whom the timing of M-M-R II vaccination was known, 425 women
received M-M-R II vaccine during the 30 days prior to conception through the second trimester. The
outcomes for these 425 prospectively followed pregnancies included 16 infants with major birth defects, 4
cases of fetal death and 50 cases of miscarriage. No abnormalities compatible with congenital rubella
syndrome have been identified in patients who received M-M-R II vaccine. Rubella vaccine viruses can
cross the placenta, leading to asymptomatic infection of the fetus. Mumps vaccine virus has also been
shown to infect the placenta {14}, but there is no evidence that it causes congenital malformations or
disease in the fetus or infant .
The CDC established the Vaccine in Pregnancy registry (1971-1989) of women who had received
rubella vaccines within 3 months before or after conception. Data on 1221 inadvertently vaccinated
pregnant women demonstrated no evidence of an increase in fetal abnormalities or cases of Congenital
Rubella Syndrome (CRS) in the enrolled women {15}.
8.2 Lactation
Risk Summary
It is not known whether measles or mumps vaccine virus is secreted in human milk. Studies have
shown that lactatingpostpartum women vaccinated with live attenuated rubella vaccine may secrete the
virus in breast milk and transmit it to breast-fed infants.{16,17} In the breast-fed infants with serological
evidence of rubella virus vaccine strain antibodies, none exhibited severe disease; however, one
exhibited mild clinical illness typical of acquired rubella.{18,19}
The developmental and health benefits of breastfeeding should be considered along with the mother’s
clinical need for M-M-R II, and any potential adverse effects on the breastfed child from M-M-R II or from
the underlying maternal condition. For preventive vaccines, the underlying maternal condition is
susceptibility to disease prevented by the vaccine.
8.4 Pediatric Use
M-M-R II vaccine is not approved for individuals less than 12 months of age. Safety and effectiveness
of measles vaccine in infants below the age of 6 months have not been established [see Clinical Studies
(14)]. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have
not been established.
8.5 Geriatric Use
Clinical studies of M-M-R II did not include sufficient numbers of seronegative subjects aged 65 and
over to determine whether they respond differently from younger subjects.
11 Description
M-M-R II vaccine is a sterile lyophilized preparation of (1) Measles Virus Vaccine Live, an attenuated
line of measles virus, derived from Enders' attenuated Edmonston strain and propagated in chick embryo
cell culture; (2) Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in
chick embryo cell culture; and (3) Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated
rubella virus propagated in WI-38 human diploid lung fibroblasts. {20,21} The cells, virus pools,
recombinant human serum albumin and fetal bovine serum used in manufacturing are tested and
determined to be free of adventitious agents.
After reconstitution, each 0.5 mL dose contains not less than 3.0 log10 TCID50 (tissue culture infectious
doses) of measles virus; 4.1 log10 TCID50 of mumps virus; and 3.0 log10 TCID50 of rubella virus.
Each dose is calculated to contain sorbitol (14.5 mg), sucrose(1.9 mg), hydrolyzed gelatin (14.5 mg),
recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin
and other buffer and media ingredients. The product contains no preservative.
6
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
M-M-R II vaccination induces antibodies to measles, mumps, and rubella associated with protection
which can be measured by neutralization assays, hemagglutination-inhibition (HI) assays, or enzyme
linked immunosorbent assay (ELISA) tests. Results from efficacy studies or effectivenes s studies that
were previously conducted for the component vaccines of M-M-R II were used to define levels of serum
antibodies that correlated with protection against measles, mumps, and rubella [see Clinical Studies (14)].
12.6 Persistence of Antibody Responses After Vaccination
Neutralizing and ELISA antibodies to measles, mumps, and rubella viruses are still detectable in 95-
100%, 74-91%, and 90-100% of individuals respectively, 11 to 13 years after primary vaccination. {22-28}
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
M-M-R II vaccine has not been evaluated for carcinogenic or mutagenic potential or impairment of
fertility.
14 CLINICAL STUDIES
14.1 Clinical Efficacy
Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind
controlled trials. {29-34} These studies also established that seroconversion in response to vaccination
against measles, mumps and rubella paralleled protection. {35-38}
14.2 Immunogenicity
Clinical studies enrolling 284 triple seronegative children, 11 months to 7 years of age, demonstrated
that M-M-R II vaccine is immunogenic. In these studies, a single injection of the vaccine induced measles
HI antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of
susceptible individuals.
A study of 6-month-old and 15-month-old infants born to mothers vaccinated with a measles vaccine in
childhood, demonstrated that, following infant and toddler vaccination with Measles Virus Vaccine, Live
(previously US-licensed, manufactured by Merck), 74% of the 6-month-old infants developed detectable
neutralizing antibody titers while 100% of the 15-month-old infants vaccinated with Measles Virus
Vaccine, Live or M-M-R II vaccine developed neutralizing antibodies {39}. When the 6-month-old infants
of immunized mothers were revaccinated at 15 months with M-M-R II vaccine, they developed antibody
titers similar to those of toddlers who were vaccinated previously at 15-months of age.
15 REFERENCES
1. General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices, MMWR
43(RR-1): 1-38, January 28, 1994.
2. Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, a n d Co n g e nita l Ru b e lla
Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practice s (ACIP), M M WR
47(RR-8): May 22, 1998.
3. Kelso, J.M.; Jones, R.T.; Yunginger, J.W.: Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gel atin , J.
Allergy Clin. Immunol. 91: 867-872, 1993.
4. Bitnum, A.; et al: Measles Inclusion Body Encephalitis Caused by the Vaccine Strain of Measles Virus. Cl i n . In fect. Di s. 2 9 :
855-861, 1999.
5. Angel, J.B.; et al: Vaccine Associated Measles Pneumonitis in an Adult with AIDS. Annals of Internal Medicine, 129: 1 0 4 -1 06 ,
1998.
6. Cecinati V, et al. Vaccine administration and the development of immune thrombocyto pe ni c p urp u ra i n ch i ld re n. Hu m an
Vaccines & Immunotherapeutics 9:5, 2013.
7. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic
Review of the Literature and Guidance for Management. J Ped 156(4): 2010.
8. Andrews N, Stowe J, Miller E, Svanstrom H, Johansen K, Bonhoeffer J, et al. A collaborative approach to investigating th e ri sk
of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark. Vaccine. 2012;30:3042‐6.
9. Rubella Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP), MM WR 3 9 (RR-1 5 ): 1 -1 8 ,
November 23, 1990.
7
10. Peter, G.; et al (eds): Report of the Committee on Infectious Diseases, Twenty-fourth Edition, American Academy of Pediatri cs,
344-357, 1997.
11. Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP), MMWR 38(S-9): 5-22,
December 29, 1989.
12. Eberhart-Phillips, J.E.; et al: Measles in pregnancy: a descriptive study of 58 cases. Obstetrics and Gynecology, 82(5): 797-801,
November 1993.
13. Jespersen, C.S.; et al: Measles as a cause of fetal defects: A retrospective study of ten measles epidemics in Greenland. Acta
Paediatr Scand. 66: 367-372, May 1977.
14. Yamauchi T, Wilson C, Geme JW Jr. Transmission of live, attenuated mumps virus to the hu m a n p l ace n ta . N En g l J M e d .
1974;290(13):710‐712.
15. Rubella Vaccination during Pregnancy —United States, 1971-1988. JAMA. 1989;261(23):3374–3383.
16. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. II.
Maternal-neonatal interactions, J. Infect. Dis. 145: 661-666,1982.
17. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. I.
Development and characterization of specific immunologic reactivity in breast milk, J. Infect. Dis. 145: 654-660, 1982.
18. Landes, R.D.; Bass, J.W.; Millunchick, E.W.; Oetgen, W.J.: Neonatal rubella following postpartum maternal i mm un izatio n , J.
Pediatr. 97: 465-467, 1980.
19. Lerman, S.J.: Neonatal rubella following postpartum maternal immunization, J. Pediatr. 98: 668, 1981. (Letter)
20. Plotkin, S.A.; Cornfeld, D.; Ingalls, T.H.: Studiesof immunization with living rubella virus: Trialsin children with a strain culture d
from an aborted fetus, Am. J. Dis. Child. 110: 381-389, 1965.
21. Plotkin, S.A.; Farquhar, J.; Katz, M.; Ingalls, T.H.: A new attenuated rubella virus grown in human fi bro b la sts: Evi d e n ce fo r
reduced nasopharyngeal excretion, Am. J. Epidemiol. 86: 468-477, 1967.
22. Weibel, R.E.; Carlson, A.J.; Villarejos, V.M.; Buynak, E.B.; McLean, A.A.; Hilleman, M.R.: Clinical and Labo ra tory Stu d ie s o f
Combined Live Measles, Mumps, and Rubella Vaccines Using the RA 27/3 Rubella Virus, Proc. So c. Exp . Bi ol. M e d. 1 6 5 :
323-326, 1980.
23. Watson, J.C.; Pearson, J.S.; Erdman, D.D.; et al: An Evaluation of Measles RevaccinationAmong School-Entry Age Ch i ld re n,
31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract #268, 143, 1991.
24. Unpublished data from the files of Merck Research Laboratories.
25. Davidkin, I.; Jokinen, S.; Broman, M. et al.: Persistence of Measles, Mumps, and Rubella Antibodies in a n M M R -Va ccina ted
Cohort: A 20-Year Follow-up, JID 197:950–6, April 2008.
26. LeBaron, W.; Beeler J.; Sullivan, B.; et al.: Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a
Postelimination Environment, Arch Pediatr Adolesc Med. 161:294-301, March 2007.
27. LeBaron, C.; Forghani, B.; Beck, C. et al.: Persistence of Mumps Antibodies after 2 Doses of Measles-Mumps-Rubella Vaccine,
JID 199:552– 60 , February 2009.
28. LeBaron, W.; Forghani, B.; Matter, L. et al.: Persistence of Rubella Antibodies after 2 Doses of Measles-Mumps-Rubella
Vaccine, JID 200:888–99, September 2009.
29. Hilleman, M.R.; Buynak, E.B.; Weibel, R.E.; et al: Development and Evaluation of the Moraten MeaslesVirusVa cci n e , JAM A
206(3): 587-590, 1968.
30. Weibel, R.E.; Stokes, J.; Buynak, E.B.; et al: Live, Attenuated Mumps Virus Vaccine 3. Clinical and Serologic Aspects in a Fiel d
Evaluation,N. Engl. J. Med. 276: 245-251, 1967.
31. Hilleman, M.R.; Weibel, R.E.; Buynak, E.B.; et al:Live, Attenuated Mumps VirusVaccine 4. ProtectiveEfficacy as Measure d i n
a Field Evaluation, N. Engl. J. Med. 276: 252-258, 1967.
32. Cutts, F.T.; Henderson, R.H.; Clements, C.J.; et al: Principles of measles control, Bull WHO 69(1): 1-7, 1991.
33. Weibel, R.E.; Buynak, E.B.; Stokes, J.; et al: Evaluation Of Live Attenuated Mumps Virus Vaccine, Strain Jeryl Lynn, First
International Conference on VaccinesAgainst Viral and Rickettsial Diseases of Man, World Health Organization, No. 147, M a y
1967.
34. Leibhaber, H.; Ingalls, T.H.; LeBouvier, G.L.; et al: Vaccination With RA 27/3 Rubella Vaccine, Am. J. Dis. Child. 123: 133-1 3 6,
February 1972.
35. Rosen, L.: Hemagglutination and Hemagglutination-Inhibition with Measles Virus, Virology 13: 139-141, January 1961.
36. Brown, G.C.; et al: Fluorescent-Antibody Marker for Vaccine-Induced Rubella Antibodies, Infection and Immunity 2(4): 360-363,
1970.
8
37. Buynak, E.B.; et al: Live Attenuated Mumps Virus Vaccine 1. Vaccine Development, Proceedings of the Society for
Experimental Biology and Medicine, 123: 768-775, 1966.
38. Hilleman M.R., Studies of Live Attenuated Measles Virus Vaccine in Man: II. Appraisal of Efficacy. Amer. J. o f Pu b l ic He a lth ,
52(2):44-56, 1962.
39. Johnson, C.E.; et al: Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles
Vaccine Era, Pediatrics, 93(6): 939-943, 1994.
16 HOW SUPPLIED/STORAGE AND HANDLING
No. 4681 ⎯ M-M-R II vaccine is supplied as follows:
(1) a box of 10 single-dose vials of lyophilized vaccine (package A), NDC 0006-4681-00
(2) a box of 10 vials of diluent (package B)
Exposure to light may inactivate the vaccine viruses.
Before reconstitution, refrigerate the lyophilized vaccine at 36°F to 46°F, (2°C to 8°C).
Store accompanying diluent in the refrigerator with the lyophilized vaccine or separately at room
temperature (68° to 77°F, 20° to 25°C). Do not freeze the diluent.
Administer M-M-R II vaccine as soon as possible after reconstitution. If not administered immediately,
reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from light, for up to 8
hours. Discard reconstituted vaccine if it is not used within 8 hours.
For information regarding the product or questions regarding storage conditions, call 1-800-
MERCK-90 (1-800-637-2590).
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Package Insert).
Discuss the following with the patient:
• Provide the required vaccine information to the patient, parent, or guardian.
• Inform the patient, parent, or guardian of the benefits and risks associated with vaccination.
• Question the patient, parent, or guardian about reactions to a previous dose of M-M-R II vaccine
or other measles-, mumps-, or rubella-containing vaccines.
• Question females of reproductive potential regarding the possibility of pregnancy. Inform female
patients to avoid pregnancy for 1 month following vaccination [see Contraindications (4.5) and
Use in Specific Populations (8.1)].
• Inform the patient, parent, or guardian that vaccination with M-M-R II may not offer 100%
protection from measles, mumps, and rubella infection.
• Instruct patients, parents, or guardians to report any adverse reactions to their health-care
provider. The U.S. Department of Health and Human Services has established a Vaccine
Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events
after the administration of any vaccine, including but not limited to the reporting of events required
by the National Childhood Vaccine Injury Act of 1986. For information or a copy of the vaccine
reporting form, call the VAERS toll-free number at 1-800-822-7967, or report online at
https://www.vaers.hhs.gov.
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Assisted suicide?
Physician Assisted Suicide is the process of a doctor providing the necessary sleeping pills/lethal dose to allow a terminally ill patient to perform the life ending act. In the United States, all but four states have made physician assisted suicide (PAS) illegal.When in a situation a terminally ill patient is in, they should have the right to commit a physician-assisted suicide.
In 1994, the state of Oregon enabled the Death With Dignity Act (DWDA). With 51% voting in favor of the act, it gives terminally ill patients access to PAS. Attorney General John Ashcroft challenged the act by saying it was not “real” and that allowing doctors to do perform that, violates the Controlled Substances Act (CSA). CSA protects the regulation of doctors from performing unauthorized distributions of drugs and drug abuse. If doctors are able to assist suicides, through Ashcroft’s claim, they would be using drugs as an abuse. In the Supreme Court, petitioner Paul D. Clement argued in the case about the violation of CSA, with 6-3, “we conclude the rule is not authorized by the CSA, and we affirm the judgment of the Court of Appeals” (Gonzales V Oregon).
Patients of irreversible illnesses often develop disorders that go underdiagnosed causing them to live a life that isn’t happy for them or their family members. According to Dr. Fine of the Office of Clinical Ethics, terminally ill patients usually get depressed when dealing with intense suffering. When the patient is depressed, they may not respond to treatment as expected. If the patient is not responding to treatment well, the doctor may up the dosage of medication or consider adding antidepressants, causing the patient to be reliant on medication for the rest of their life.
Patients who receive a terminal diagnosis usually experience high levels of anxiety.  According to Dr. Fine, anxiety can cause problems such as, agitation, insomnia, restlessness, sweating, tachycardia, hyperventilation, panic disorder, worry, or tension. Sleep deprivation plays a huge part in the anxiety the patients feel. The patient’s sleep is often interrupted many nights and several times to get their blood pressure checked, blood withdrawals, checkings of veins, etc. Because these medical requirements can not be withheld, many doctors may feel the need to heavily sedate the patient to make them feel lucid during the day time.
Studies have shown that patients of terminal illnesses fear that they’d burden their families. The patients feel, “grief and fear not only for their own future but also for their families’ future” (Johnson), researchers say. The feelings of being in the way can cause emotional, physical, social, and financial problems. In  doctors Johnson, Nolan, and Sulmasy’s research, they found that feelings of burden are most likely to affect emotional symptoms, quality of life, and patient satisfaction. Wanting to feel like they aren’t a burden to their families and society was most important to patients seen by the doctors. The research the doctors conducted found that out of a list of 28 qualities, the wish to not be a physical or emotional burden on family, 93% of respondents said that this was very or extremely important to them. The doctors made three categories of experiences that were related to “self-perceived burden” (Johnson). The first one being “concerns for other” (Johnson), then “implications for self” (Johnson), and last being “minimizing the burden” (Johnson). Feeling like a burden can cause “empathic concern engendered from the impact on others of one’s illness and care needs, resulting in guilt, distress, feelings of responsibility, and diminished sense of self” (Johnson).
To let a patient commit an assisted suicide means, they’re freed from pain. To force someone who knows that their time's coming to an end quickly when they do not wish to be in pain anymore should be a crime. In Epidemics, Book 1, it states, “practice two things in your dealings with disease: either help or do not harm the patient”, by allowing the patient to continue their life is harming them, all physically, mentally, and spiritually. Doctors take an oath, the Hippocratic Oath when practicing medicine. In the oath, there is a phrase that says “Also I will, according to my ability and judgment, prescribe a regimen for the health of the sick; but I will utterly reject harm and mischief”, if the patient has considered an assisted suicide, they’ve been in too much pain and wish for it to end. Refusing them the help causes them more physical and emotional pain; physical being the illness itself and emotional being the feeling of being a burden.
Patients with terminal illnesses have the right to commit assisted suicides because it allows them to end their life from something no drug would be able to fix. With the illness being irreversible, dragging it out will cause both suffering and financial problems. Terminally ill patients have the right to die with dignity. Dying by choice will let their loved ones know that they are ready and have accepted their fate, easing weight off their families shoulders. Having the ability to die will portray the patients as human beings who want to make one last decision before going rather than people who are laying in a hospital bed waiting to die. A patient knows that the doctor’s job is to relieve pain, with a doctor refusing their wish, only cause distrust in their relationship. Letting assisted suicide would allow their families to begin healing. By refusing the patient their right to die, forces them to live a poor quality of life no one would ever wish upon anybody. It is in everyone’s interest to let them go. Doctors have a responsibility to make the patient happy and to relieve them of any kind of pain, letting them go is relieving them of the pain they wish to no longer feel. PAS gives them the ability to go happily and contently.