In most U.S. healthcare settings, full code is the default. Unless there is a valid order or legally recognized document limiting resuscitation, staff are expected to provide cardiopulmonary resuscitation (CPR) and related interventions, such as chest compressions, defibrillation, emergency medications, and airway management including intubation and mechanical ventilation.

This default exists because, in an emergency, there’s rarely time to ask what the patient would want. The law and medical ethics both lean toward preserving life when a patient’s wishes are unknown. That makes full code different from other code statuses: it doesn’t require the patient to actively choose it, while limitations like a do-not-resuscitate (DNR) order must be clearly documented and authorized.

Several legal principles shape how code status is handled:

• Informed consent and the right to refuse: U.S. law recognizes that competent adults have the right to accept or refuse medical treatment, including life-sustaining treatment. Full code status is ultimately grounded in the patient’s choice, or the presumption of it.
• The Patient Self-Determination Act (1990): this federal law requires hospitals, nursing facilities, and other providers that participate in Medicare and Medicaid to inform adult patients of their rights under state law to make decisions about their care, including the right to create advance directives.
• State law: each state sets its own rules for advance directives, surrogate decision-makers, DNR orders, and portable medical orders such as POLST or MOLST forms. These rules determine which documents are valid and who can make decisions when a patient can’t.

Because requirements differ by state, organizations need policies that reflect the laws where they operate, and staff need training on them.

Code status decisions draw on the core principles of medical ethics:

• Autonomy: respecting the patient’s right to make decisions about their own body and care.
• Beneficence: acting in the patient’s best interest.
• Non-maleficence: avoiding harm. CPR can save lives, but it can also cause injury and may not achieve meaningful benefit for some patients.
• Justice: treating patients fairly and consistently.

Most ethical challenges arise when these principles pull in different directions. For example, a patient or family may request full code even when the care team believes resuscitation is unlikely to help. These situations call for honest conversations, careful documentation, and, when needed, involvement from the organization’s ethics committee. Policies on medically non-beneficial treatment vary widely, so teams should know their own institution’s process.

When a patient lacks decision-making capacity, code status decisions usually fall to a surrogate. That may be a health care agent named in a durable power of attorney, a court-appointed guardian, or a family member identified under the state’s surrogate hierarchy. Surrogates are generally expected to use substituted judgment, choosing what the patient would have wanted, and to rely on best interest only when the patient’s wishes aren’t known.

Advance directives and portable orders help prevent uncertainty. A living will describes a patient’s wishes in advance, while a POLST or similar form translates those wishes into actionable medical orders. Care teams should check for these documents on admission and whenever a patient’s condition changes significantly. For frontline staff, our article on full code status for frontline care teams covers the practical side.

From a legal and compliance standpoint, code status is only as reliable as its documentation. Best practices include:

• Recording code status clearly in the medical record and making it visible to every member of the care team.
• Documenting the conversation behind the decision, including who was present, what options were discussed, and the patient’s or surrogate’s understanding.
• Reviewing code status at key transitions, such as admission, transfer between units, a major change in condition, and discharge.
• Making sure orders written in one setting are properly carried over or reconciled in the next.

Errors such as a missing DNR order, an outdated code status, or conflicting documents can lead to unwanted treatment or failure to resuscitate, both of which carry serious ethical and legal consequences. Good documentation also supports accurate coding and billing for advance care planning services, such as CPT 99497 and 99498, when those conversations meet the requirements.