Italy's overwhelmed coronavirus doctors are being forced to choose between who lives and who dies during the spiralling crisis.
Older or sicker patients are being given inadequate care and left to die so doctors and nurses can focus on patients who are younger and more likely to survive.
Compared to wartime guidance, the grim advice highlights the moral dilemmas for staff at hospitals which are unable to cope with so many patients and not enough workers, beds or equipment.
Patients who have a limited number of "life years" left, even if they could survive, should be left to die, they have been told.
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The elderly and people with pre-existing conditions are most at risk of dying.
Italy and its 60million residents are under an unprecedented lockdown in a desperate bid to control Covid-19, which has infected more than 12,000 people and killed 827.
The guidelines published by Italy's College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) were drafted by medical doctors.
They urge medics "to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care", The Atlantic reported.
According to the recommendations, "it may become necessary to establish an age limit for access to intensive care".
The guidelines state: “What might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”
The advice applies to patients in intensive care for reasons other than Covid-19.
Overstretched doctors have spoken out about working on the front lines of the fight against the epidemic.
Dr Christian Salaroli, from the badly-affected Lombardy region, told Il Corriere della Sera: "If a person between 80 and 95 years old has serious breathing difficulties, it’s likely we will not proceed (with treatment).
"If they have multi-organ failure, with more than two or three vital organs, it means that their mortality rate is 100 per cent."
He added: “To say that you do not die from the coronavirus is a lie that fills me with bitterness."
In a post that has been widely shared on Facebook, Dr Daniele Macchini, a doctor in Bergamo, likened the virus to a "tsunami that has swept us all".
He added: "The situation is now nothing short of dramatic. No other words come to mind.
"The war has literally exploded and the battles are uninterrupted day and night.
"Let's stop saying it's a bad flu."
Italy, which has the second highest infection total behind mainland China, has tightened its lockdown by shutting bars, restaurants, hairdressers and other stores for two weeks.
Supermarkets and chemists are allowed to remain open.
Its restrictions are the most severe controls on a Western nation since World War II.
The World Health Organisation has declared coronavirus a pandemic.
More than 126,000 people have been infected worldwide.
