Edna at 15: looking back and looking ahead.

continuing this treatment contrasts with good comfort care at the end of life.3-5 Research since Edna shows that medically supplied nutrition and hydration does not improve survival among patients with advanced dementia, and increases the risks of aspiration, pneumonia, and gastrointestinal discomfort.6-10 Since the Nancy Cruzan and Terri Schiavo cases in the 1990s, many medical organizations have issued statements on the administration and discontinuation of medically supplied nutrition and hydration.11-14 Some positions are stronger than others. The American Academy of Neurology maintains that decisions about the use of nutrition and hydration should fall outside the scope of any state or federal oversight or judicial intervention. Common to these positions is the view that medically supincluding nutrition and hydration, may be withheld or withdrawn from persons in PVS, since persons in this condition have no clear interest in or receive any benefit from such treatment, and do not sense things like pain, hunger, or thirst.2 The Court also upheld the right of patient self-determination; if patients have clearly stated their preferences to forgo life-