Terminally ill patients frequently have difficulties with fluid and food intake. The indication of artificial hydration in these patients has been subject of intense debate in the past years and the clinical practice widely varies, mostly based on anecdotal data and not on clinical evidence about risks and benefits associated to artificial hydration in terminal patients. There are not only technical questions concerning benefits and risks associated to artificial hydration, but also questions related to the ethical principles and values involved. Several topics, such as the effect of artificial hydration alleviating symptoms or reversing neurological alterations as delirium, its life prolonging effect or if it promotes unnecessary suffering, are discussed. In this review we will analyze clinical benefits and risks associated to artificial hydration in terminal patients, making reference to some ethical principles involved.