The issue of medically administered nutrition and hydration (MN&H) at the end of life has generated public, professional and academic controversy in a number of countries. There is a dearth of published documentation of how hospice and palliative care services care for dying patients without routine recourse to these measures, as they almost universally do. This descriptive longitudinal study was therefore conducted to document practice and inform debate. Using grounded theory, it explored the experience of palliative care patients and families with regard to nutrition and hydration at the end of life. It shows that for dying patients there is neither an abrupt cessation of food and fluid nor any sign of suffering attributable to the decline in oral intake. Instead there is a gradual decrease in intake, and providing good mouth care is undertaken, patients do not suffer the ill effects of terminal dehydration. Family members in this study were, however, under the impression that any non-provision of fluid and nutrition would result in suffering for the dying person, indicating that there is an ongoing need for public education and family support regarding this aspect of palliative care.