I reemphasize, despite the notice being oral, no consent is required. If a patient or surrogate objects, it must be in writing
(e) If the patient or surrogate disagrees with the DNAR order being placed in or removed from the medical record, the patient or surrogate may request in writing and is entitled to a consultation or a review of the disagreement by the ethics or medical committee in the manner described by Section 166.046, with the patient or surrogate afforded all rights provided to the surrogate under that section, and with the physician afforded all protections from liability provided under Section 166.045(d)
Thus, the burden of objecting is placed on the sick patient, who is probably weak and may be unable to get out of bed–or the family. Many will be hesitent, given that the doctor and hospital hold the patient’s life in their hands. Not only that, some will be uneducated and feel incapable of standing against people who may be more educated and part of the institutional culture.
Also note that the letter requests that an ethics committee meeting be convened. Most members of that ethics committee will be employees of the hospital and others will be volunteers from the community with a close connection to the hospital. They will know the physician, who will probably be a hospitalist, also an employee or a contract doctor paid by the hospital. It is also worth mentioning that the ultimate deciders will be strangers to the patient empowered to veto the patient’s advance directive.
Not only that, but a doctor who imposes a DNAR order is completely free from liability, as are the facility and other personnel. But if a doctor does not impose a DNAR, he or she remains potentially liable for mistakes or negligence. In other words, in close cases, the incentive is to impose the DNAR.
Once the written request is made and the ethics committee process started, the DNAR comes off the chart. But the ethics committee can still force it back on without consent in a secret decision making process afer all parties have been heard. At that point, the only option for the patient is to find a different hospital. Good luck with that.