Doctors may have to decide which severely ill patients to treat based on a lottery if the NHS is overwhelmed this winter under draft Covid rationing plans.
The guidance also advises medics look at patients potential to contribute to society or their likelihood of surviving the treatment as a way to prioritise whose lives should be saved.
The protocol says that for patients who are in similar health and cannot be separated in other ways, a random allocation, such as a lottery, may be used .
The document, published in the Journal for Medical Ethics in November, was drawn up by experts at a major NHS Trust in Bath in an attempt to come up with a system for rationing care in the event there are not enough resources to treat everyone.
Maternity services are facing disruption across the South East because ambulance staff are too busy dealing with spiralling coronavirus hospitalisations.
The East Sussex NHS Trust and Brighton and Sussex NHS Trust have both suspended services for home-births and their stand-alone midwife-led units because they cannot guarantee an ambulance can turn up if there is an issue.
Four other trusts all in Kent, one of the places worst-hit by England s second wave have also paused their home-births service for the same reason.
It comes as hospital chiefs warn hundreds of intensive care patients may have to be moved between regions to take the pressure off the most over-stretched wards.