What Is “Code Status” — and Why Would Someone Choose Not to Be “Full Code, Full Tube”?

Last Updated: November 2025

Medically Reviewed by Dr Jessica Knape, MD MA-Board Certified in Internal Medicine and Integrative and Holistic Medicine

Overview

• “Code status” is a medical term that tells your healthcare team how far to go if your heart or breathing stops.

• “Full code” means you want all life-saving measures (CPR, defibrillation, breathing tubes, ICU care).

• Some people choose “Do Not Resuscitate (DNR)” or “Do Not Intubate (DNI)” when aggressive interventions would likely cause more harm than benefit, especially in advanced illness.

• The goal is not “doing nothing” — it’s choosing comfort, dignity, and control over how you spend the end of your life.

What “Code Status” Really Means

Every adult admitted to a hospital is asked their code status — essentially, what you would want done in an emergency like:

• Cardiac arrest (heart stops)

• Respiratory failure (can’t breathe independently)

Your choice determines how the team responds if you become unresponsive.

Common Code Status Options

• Full Code: All resuscitative measures are performed — chest compressions (CPR), electric shocks, breathing tube, mechanical ventilation, medications, and ICU-level care.

• DNR (Do Not Resuscitate): No CPR or electric shocks if the heart stops. Comfort measures only.

• DNI (Do Not Intubate): CPR may be attempted, but no breathing tube or mechanical ventilation if breathing fails.

• Comfort-Focused / DNR–DNI: Focus entirely on symptom relief (oxygen, pain and anxiety control, natural passing without aggressive life support).

Why “Full Code, Full Tube” Isn’t Always the Best Choice

 1. CPR in real life is very different from TV

On medical dramas, people often survive CPR and walk out of the hospital.
In real life, survival is much lower — especially for older or chronically ill patients.

• Healthy adults (witnessed arrest in hospital): 20–25% chance of surviving CPR to discharge

• Frail older adults: 5–10% chance of surviving CPR to discharge

• Terminal illness (advanced cancer, dementia, heart failure): <1–2% chance of surviving CPR to discharge

Even if the heart restarts, many survivors have brain injury, fractures, or prolonged ICU stays requiring machines.

2. “Full tube” (intubation) can prolong suffering

Mechanical ventilation saves lives in reversible conditions (like pneumonia in a healthy adult).
But in advanced illness — cancer, dementia, end-stage heart or lung disease — it often:

• Doesn’t change the underlying disease

• Requires sedation and restraint

• Prevents eating, speaking, or meaningful interaction

• May lead to prolonged ICU dependency or death on a ventilator

This can extend the dying process without restoring quality of life.

3. It’s about values, not “giving up”

Choosing not to be “full code, full tube” means prioritizing comfort, connection, and control over invasive procedures with low success rates.

Many people prefer:

• To die naturally, at home or in hospice

• Surrounded by family, not ICU monitors

• With pain and breathlessness managed

• With dignity and autonomy intact

As one palliative care physician often says:

“A DNR doesn’t mean do nothing — it means do the right things.”

What “Comfort Care” Actually Includes

If someone chooses not to be full code, they still receive full medical attention focused on comfort:

• Oxygen and breathing support (non-invasive)

• Pain and anxiety management

• Hydration and medications as tolerated

• Emotional and spiritual support

• Skilled nursing and palliative care oversight

How to Decide What’s Right for You

1. Talk with your doctor early — ideally before you’re hospitalized.
   Ask: “What would CPR or a breathing tube look like for someone in my condition?”

2. Reflect on your values.
   What matters most — time, independence, comfort, or avoiding suffering?

3. Use an advance directive or living will.
   This documents your wishes clearly so your loved ones aren’t forced to guess.

4. Appoint a medical durable power of attorney (DPOA).
   This person can speak for you if you can’t communicate.

5. Revisit your decision regularly.
   Code status can change if your condition or goals change.

Common Misconceptions

Myth: “DNR means no care.”

Reality: You still receive full medical care focused on comfort and dignity.

Myth: Doctors will give up on me.”

Reality: The medical team honors your wishes and may continue treating reversible problems.

Myth: “I’ll lose control.”

Reality: Choosing a code status is control — it ensures your values guide care, not crisis.

Myth: “Only very old people need this.”

Reality: Everyone over 18 should document preferences, regardless of age.

A Realistic Perspective

Many patients choose “Full Code” when they’re healthy or early in illness.
As disease progresses, some shift toward “DNR/DNI — comfort-focused” because:

• Aggressive interventions would not restore meaningful life

• They want natural closure surrounded by loved ones

• They prioritize quality over quantity of days

Having this conversation early — before a crisis — ensures decisions come from clarity, not panic.

Summary

“Code status” is not just a hospital checkbox — it’s a reflection of your values.

• Full code means doing everything medically possible to restart life.

• DNR/DNI or comfort care means focusing on quality, not prolonging suffering.

There’s no right or wrong choice — only what aligns with your goals, beliefs, and definition of a good life (and death).
At Healthspan Internal Medicine, these conversations are an act of precision compassion: ensuring care is both medically sound and personally meaningful.

Sources

• American Heart Association. CPR Survival and Outcomes Data (2020 Guidelines Update).

• Ehlenbach WJ, et al. Epidemiologic Study of In-Hospital CPR Outcomes. NEJM. 2009;361:22–31.

• National Institute on Aging. Understanding Health Care Decisions at the End of Life.

• Mayo Clinic Staff. Do-Not-Resuscitate Orders: What They Mean and How to Decide.

• Colorado Department of Public Health & Environment. CPR Directive / DNR Forms.
  
  

Medically reviewed by
Dr. Jessica Knape, MD, MA Board Certified in Internal Medicine and Integrative and Holistic Medicine
Healthspan Internal Medicine — serving patients in Boulder, CO

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This content is for educational purposes and does not replace personalized medical advice.