There is a lack of clear evidence regarding the benefits and harm of artificial hydration at the end of life. Trial findings are conflicting and inconclusive, offering little basis for recommendations. As a result, the advantages and disadvantages of artificial hydration remain largely anecdotal, and decisions about its use, withholding or withdrawal are often based on opinion rather than evidence. In certain circumstances, some patients who are dying might derive benefit from artificial hydration in terms of reducing specific symptoms, such as delirium. This article explores the central questions pertaining to artificial hydration at the end of life by undertaking a critical exploration of the relevant literature.