I just re-read the February 8, 1984 Queens County, New York Grand Jury statement of findings in the the so-called "purple dots" case. 49(6) Conn. Med. 367. In the early 1980s, there was no mechanism in New York for DNR orders. But there were patients for whom CPR was clearly inappropriate. Having no "green light" (aka legal uncertainty) to provide the medicine that they thought right, some physicians made patients DNR secretly. They ever documented the orders in writing, but rather through secret codes such as purple dot stickers.
What I had not caught before was that the this approach was pushed primarily by the lawyers. Ultimately, the Grand Jury sympathized with the physician's dilemma (good medicine = legal risk). But it still felt that an entirely non-transparent process created too many risks of corruption, carelessness, and bias.