It may be in the interests of dementia patients who cannot eat safely not to be fed, even if that leads to their deaths, an inquest has heard.
Retired High Court judge Sir Richard Rougier is overseeing the inquests
The inquest is into the deaths of 11 elderly and psychiatric patients during the 1990s at Kingsway Hospital, Derby.
Workers have claimed terminally-ill patients were unnecessarily deprived of food and water and allowed to die.
Consultant psychiatrist Dr Maureen Royston told the inquest not feeding could be in patients' "best interests".
Derby coroner Peter Ashworth said the inquest had been convened because "a sizeable number of nurses" had alleged food and fluids were withdrawn "at a time when they were perfectly capable of accepting it, all because it was arbitrarily decided that it was time for them to die".
A police investigation launched in 1997 led to the suspension of three hospital workers, but no-one was charged.
Dr Royston said many patients with dementia suffered eating difficulties or a lack of interest in food, which can lead to choking or pneumonia.
Leading the inquiry, retired High Court judge Sir Richard Rougier asked: "If a patient has reached a stage where he simply cannot ingest anything without choking then presumably there is nothing else you can do but withdraw food and liquid and let nature take its course?"
Dr Royston replied: "I have been involved in that scenario where it became quite clear that a patient cannot swallow anything safely and the best interests of that patient would be not to continue and not to put them through what must be an unpleasant experience."
THE 11 DEAD (AND DATES OF DEATH) ARE:
Robert Leslie Burgess, 72, electrician, Spondon, Derby - May 1995
William Smart, 84, joiner, Alvaston, Derby - August 1995
Ernest Smith, known as Mick, 92, retired ward, Mackworth - September 1995
William Robert Thorpe, 81, retired foundry man, Sandiacre - July 1996
Mico Vukovojac, 81, retired labourer of Littleover, Derby - October 1996
William John Smith, 87, retired civil servant, Long Eaton - November 1996
Sidney Burton Jowett, 77, retired chief fire officer, Mickleover, Derby - February 1997
Andrew Hughson, 74, retired farmer, Etwall, Derbyshire - February 1997
Ernest Smith, known as Simon, 93, retired personnel manager, Ilkeston, Derbyshire - May 1997
James Edward Keenan, 67, retired slinger, Sinfin, Derby - May 1997
Arthur Samuel Boddice, 81, retired progress chaser, Swadlincote - July 1997
Sir Richard said: "If it should transpire that food and fluids were withdrawn in good faith... committing them to die in as much comfort and dignity as possible... it would be grossly unfair to record a verdict other than that of death by natural causes."
The hearing is likely to last up to three months and is expected to involve more than 40 witnesses.
The inquests are being held at Pride Park Stadium as the city's coroner's court was not big enough.
The patients were on the Kingsway Hospital's Rowsley ward and died between 1995 and 1997.
The inquest heard all 11 were in the terminal stages of senile dementia and died from bronchial pneumonia between 1995 and 1997.
Police sent a file to the Crown Prosecution Service, which decided not to pursue criminal action.
Derbyshire Mental Health Services NHS Trust is thought to be waiting for the inquests to be held before making a decision on the suspended workers.
The Department of Health is also awaiting the results before considering an independent inquiry.
Lawyer Chris Gawne, of Alexander Harris solicitors, representing the families of seven patients, said they were anxious to know what kind of treatment had been given.
Speaking before the inquest, he said nursing staff often indicated to families that it was not safe for patients to be given food and water as a result of swallowing difficulties.
But he said the hearings would look into whether more could have been done to allow food and water to be provided in certain instances.
The 18-bed ward for elderly male patients suffering long-term illness closed in 2001.
Mike Smith, whose father died at the ward, said: "It was very difficult to judge whether the treatment he was receiving was of an acceptable standard."
Mike Shewan, chief executive of Derbyshire Mental Health Services Trust, welcomed the hearing, saying: "The long investigations have been an ordeal for both the families and staff members concerned.
"We can now finally look forward to hearing all the evidence and await the coroner's verdict on how these patients died."
The 250-bed low-security hospital provided long-term psychiatric care for mainly geriatric patients.