Code status decisions are often framed as "do everything" or "do nothing." In practice there are four distinct options, each with its own scope of care. Each provides different things — not different amounts of the same thing.
When goals-of-care conversations frame the choice as "do everything" or "do nothing," the actual options can be obscured. There are four distinct paths. Each provides a different scope of care if the patient's condition deteriorates.
The matrix to the right shows the scope of each option across seven categories of intervention.
All life-sustaining interventions if the heart stops or breathing fails: chest compressions, defibrillation, intubation, mechanical ventilation, ICU care, and vasopressors. Active treatment of any underlying illness continues. This is the default code status in most US hospitals unless another order is specified.
Routine symptom management (pain medications, anti-nausea, etc.) is provided alongside but is not the primary focus. Specialist palliative input and hospice services are not part of this option by default.
The same scope of intervention as Full Code, but with a pre-agreed reassessment point — commonly 72 hours to one week. If the patient is improving according to mutually agreed clinical markers, treatment continues. If not, goals are reassessed, often shifting toward comfort care.
Time-limited trials are supported by professional society guidelines and are increasingly used to avoid prolonged interventions when benefit is unclear.
If the heart stops or breathing fails, no CPR is attempted: no chest compressions, no defibrillation, no intubation for resuscitation. But all other treatments continue — mechanical ventilation when appropriate, antibiotics, surgery, ICU admission for non-arrest reasons, and active management of underlying conditions.
A common misconception is that DNR means "do not treat" or that staff will reduce care. It does not. DNR is sometimes combined with DNI (Do Not Intubate) or written as DNAR (Do Not Attempt Resuscitation); terminology and form requirements vary by state.
The primary focus shifts entirely to symptom management and quality of life. Pain, breathlessness, anxiety, nausea, and other symptoms are actively managed by specialists in palliative medicine — at a level of attention that is not standard outside of palliative care settings.
Hospice services (24-hour nursing support, equipment, social work, chaplaincy), psychosocial care, and family/caregiver support including bereavement services are core features of this option. These are not standard components of other code statuses.
Each option provides different things. Full Code emphasizes life-sustaining intervention. Time-Limited Trial does the same with a built-in checkpoint. DNR excludes resuscitation but keeps everything else. Comfort Care delivers specialist symptom management and psychosocial support that the other options do not.
Code status is revocable. A patient who is full code today can transition to comfort care if their condition worsens. A patient who chose comfort care can change their mind. Documentation should be updated as decisions change.
Specialist-led symptom management, psychosocial support, and family-centered care are core features of comfort care — but they are also available as palliative care consultations alongside any other option. A patient on Full Code or DNR can request palliative care to address symptom burden, prognosis discussions, or family support. This combination is associated with better quality of life and, in some cancer populations, longer survival.