Clinicians accept that the health-care budget is limited. In England, where 80% of the UK population lives, hospitals operate increasingly independently and must perform within tight financial limits defined annually and prospectively by a central regulator. The annual census for England in 2010 indicated that 3,622 general and specialty ICU beds were open, amounting to 3.5 per 100,000: approximately 15% and 25% of those available in the United States and Canada, respectively, and by far the lowest of seven developed economies in Europe.4 Unsurprisingly, 65% of clinicians felt ICU admission was often limited by bed availability5 and was a political issue in the United Kingdom in the 1990s. In 2000, this prompted a policy aimed at maximizing the usage of ICU beds, and ensuring regional networks of coverage.6 It introduced common protocol-driven systems that effectively guide resource allocation. Although England does not have legal policies concerning rationing, patients cannot demand (and receive) futile care. Rationing in this sense is, therefore, at least nominally decided according to clinical benefit rather than availability of resources. The UK General Medical Council7 admits that decisions about offered treatment options may “be complicated by resources constraints—such as funding restrictions on certain treatments in the NHS, or lack of availability of intensive care beds.” In such circumstances, clinicians are required to provide as good a standard of care as possible for the patient, while “balancing sometimes competing duties toward the wider population, funding bodies and employers.” Decisions prioritizing patients must be based upon clinical need and the patient’s capacity to benefit.7 Nonetheless, limited resources rarely dictate admission, except in extreme situations (eg, 2009 influenza A[H1N1] outbreak).