Moors Murderer Ian Brady died of natural causes, a coroner has ruled.
Christopher Sumner, senior coroner for Sefton, made the conclusion at an inquest at Bootle Town Hall in Merseyside on Thursday.
The 79-year-old serial killer, also known as Ian Stewart-Brady, died at 6.02pm on May 15 at Ashworth High Secure Hospital in Maghull, Merseyside.
Mr Sumner said he accepted the cause of death, given by Home Office pathologist Dr Brian Rodgers, as cor pulmonale, a form of heart failure, secondary to bronchopneumonia and chronic obstructive pulmonary disease, or lung disease.
He said he had to consider whether neglect or self-neglect contributed to the death, as the killer had been on intermittent hunger strike since 1999.
He said: "The evidence shows that Mr Stewart-Brady was fed by a nasogastric tube.
"He also took food to supplement that liquid diet from selected staff and it wasn't just snacks, it was full meals at times.
"Dr Rodgers' evidence is that his weight was 61kg, nine stone, and his BMI was 21.3.
"He received appropriate medical care throughout his time as a patient at Ashworth Hospital to satisfy both his physical and his mental needs.
"I, thus, find there was no evidence of neglect or self-neglect contributing to the death of Mr Stewart-Brady."
At an earlier hearing Mr Sumner refused to release Brady's body before he was given assurances the killer's ashes would not be spread on Saddleworth Moor - where the remains of four of Brady and Myra Hindley's five child victims were found.
The body was kept under police guard until it was released to his lawyer, Robin Makin, on May 18.
No reference was made to Brady's remains during Thursday's hearing.
Mr Makin, the executor of Brady's will, did not attend the inquest
Dr Rodgers said Brady had been on a number of medications, including oxygen which was administered through a mask.
He was on end-of-life care at the time of his death.
Dr Rodgers said his body was in "fairly good condition" with no evidence of pressure sores.
But he said his lungs were "very severely diseased".
He said toxicology tests showed no alcohol and levels of medication which were consistent with his end of life care.
He said: "The main pathology lay in his lungs which were totally diseased with very little normal lung tissue remaining."
The court heard Brady had been a heavy smoker until the smoking ban was introduced.
Dr Rodgers said he was not emaciated despite his intermittent hunger strikes.
Giving evidence, consultant forensic psychiatrist Dr Noir Thomas said he had acted as Brady's responsible clinician from March 2015.
Brady suffered from paranoid schizophrenia, marked by perceptual disturbances, delusional ideas, disorganised thought and speech, he explained.
There were also accounts of "disturbed and bizarre behaviour" relating to psychosis which include assaults agains peers.
His diagnosis came to the fore in 1985 alongside recognition that he suffered from a severe underlying personality disorder of promiment narcissistic and anti-social sub-types, the court heard.
He was also thought to suffer from a number of deviant sexual disorders, including sexual sadism and paedophilia.
Dr Thomas said Brady had declined to accept anti-psychotic medication and also refused to engage with either psychological assessment or therapy throughout his time at Ashworth.
He added: "His 32-year detention at Ashworth Hospital was largely marked by hostility, opposition to his care and treatment, allegations of brutaility, serial complaints and insistence of interference by the Home Office.
"He was also subject to intense, often hostile media interest."
In 1989 Brady started what he termed a "hunger strike" in protest against a ward move to which he objected, said Dr Thomas.
He was subsequently fed by nasogastric tube (NG) but his feed was often coupled with an acceptance of diet and fluids from select staff.
Mr Thomas said: "Over the last two years, brief periods were sustained, lasting maximally eight weeks, whereby Mr Brady tolerated the absence of his NG tube, accepting diet and fluids regularly.
"However each episode ended with Mr Brady recommencing absolute food and fluid refusal for a period in excess of 48 hours, such that an NG had to be passed again.
"He would then invariably accept fluids once the NG tube was resited."
The clinician said Brady continually refused to be weighed but his body mass index was not considered a concern.
The killer had "serially pursued" a move from Ashworth hospital to prison - without success at various mental health tribunals - and had talked about committing suicide, the inquest heard.
Mr Thomas said: "In recent years there was ongoing evidence of intractable narcissism with marked grandiosity, a lack of empathy, demanding and entitled behaviour.
"There was also ongoing evidence of paranoia and persecution, though no florid evidence of psychosis.
"There had been no incidents of violence but he maintained a verbally abusive, derogatory and confrontational stance against the hospital."
Mr Thomas said at 12.30pm on May 15 medics concluded that Brady was nearing death.
He told the inquest: "He was unresponsive at times, laboured in his breathing and agitated.
"He declined chaplaincy.
"He asked for his solicitor to be notified and requested that his locked briefcases be removed from his room. These were sealed by security staff and locked in the director of security's office."
After Brady was administered painkillers his physical health deteriorated over the course of the afternoon with more laboured breathing.
Mr Thomas said: "His death was considered imminent."
The clinician said he attended Ashworth's Newman Ward where a doctor told him at 5.50pm that Brady's was breathing was consistent with that prior to death.
He said: "On my arrival on the ward, I was advised that staff believed that Mr Brady had died. He was unresponsive with no evident signs of life.
"Following examination, I certified his death at 18.02 hours on 15 May 2017."
He added that three police officers arrived on the ward at 7.25pm.
In summary, Mr Thomas said: "His care and treatment in recent years remained largely unchanged, in line with the manifestations of his mental disorders which were considered resistant to treatment.
"In recent years his deteriorating physical health has been the source of concern and significant specialist input.
"Even at the end stages of his lung condition, it was felt that he was best placed within a high secure hospital setting and not returned to prison.
"His death was expected given the progressive deterioration in his physical health, and directly related to his obstructive pulmonary disease.
"The care and treatment of Mr Brady at the end of life was supported throughout by external specialists whose services were invaluable in allowing us to ensure that all aspects of his care were managed accordingly."
Earlier this year The Sun reported details of Brady's will made in 2011.
The document was said to contain instructions that two briefcases full of Brady's legal and personal papers, and his other belongings, were to be collected immediately after his death.
The inquest heard Brady was assessed by a doctor in February because of concerns about his lung function and a "marked deterioration" in his condition was noted.
The palliative care team became involved in his treatment and a "do not resuscitate" order was discussed with Brady.
His condition deteriorated significantly on April 24 when an increase in shortness of breath, distress and physical frailty was noted by doctors.
Brady removed his nasogastric tube on May 10 and it was not resited by staff.
Dr Thomas said Brady's health deteriorated further on May 12.
On May 14, the day before his death, doctors recognised he was nearing the end of his life although he appeared "rather more settled".