Can you use stampers to justify the refusal to sign a document?

Electronic signatures should NOT always reflect that something is good or positive, they can also be used to express a negative decision on something:

Electronic voting: yes, no, abstention
Medical Consent: I consent, I do not consent, I revoke consent

In terms of API, there’s the possibility to define the appearance of the stamper, including a PNG or a text string. The stamper can be placed:

Regarding the orientation: