A coroner has ruled food and drink was deliberately withdrawn from patients at a Derby hospital in the 1990s.
Retired High Court judge Sir Richard Rougier headed the inquest
But the inquest into the deaths of 11 elderly men at the Kingsway Hospital ruled that all died of natural causes.
Deputy Coroner Sir Richard Rougier said there had been "an unhappy atmosphere" in the ward where the men died.
But he added there were too many uncertainties to say the policy of withholding food - for fear of choking - contributed to their deaths.
Mr Rougier, however, criticised the management in his ruling and said doctors had left decisions about the treatment of patients to nursing staff.
The inquest heard all 11 were in the terminal stages of senile dementia and died from bronchial pneumonia between 1995 and 1997.
The inquest at Derby's Pride Park heard it was common for severe dementia patients not to be given food and drink.
Chris Gawne, a solicitor for some of the families in the case, said after the verdict: "The families are relieved that the inquests have now come to a conclusion and are confident that the causes of these patient's deaths have been properly and rigorously examined.
"The families can take comfort in the fact that their loved ones died solely because they reached the end of their natural lives."
A consultant psychiatrist had told the inquest earlier that not feeding patients could be in their "best interests".
Dr Maureen Royston said many patients with dementia suffered eating difficulties or a lack of interest in food, which can lead to choking or pneumonia.
"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," she told the inquest.
A police investigation launched in 1997 led to the suspension of three hospital workers but no-one was charged.
Sir Richard Rougier, a retired High Court judge, was appointed as a deputy coroner to handle the case as it was expected to last several months.
A witness said staff had drawn up a so-called "death list" of patients they thought had died before they should have, the inquest heard.
The 18-bed ward for elderly male patients suffering long-term illness closed in 2001.
Mike Shewan, chief executive of Derbyshire Mental Health Services NHS Trust, said after the hearing: "Dementia is a complex condition, the extent of which is yet to be fully
"That said, it is clear that the end stage of dementia involves the body simply shutting down and always leads to death.
"The inquest verdicts should reassure families and others about the care that patients received at that time."