This applies to people who would prefer that their closest platonic friend make decisions if they’re incapacitated, rather than their family; to people trying to escape abusive familial or spousal relationships; to people like me in different-sex relationships who choose not to marry; and, of course, to people in same-sex relationships who aren’t able to marry yet.  The memorandum also includes language explicitly stating that hospitals “may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability,” which is, sadly, probably necessary.  But the conceptual framework it applies is not one of slightly expanding the allowed relationships to include not only blood relation and marriage, but “marriage-equivalent” relationships; it’s a more drastic change, which rejects the assumption that blood relation and marriage are always the best proxies for patient wishes, and instead respects patient autonomy.

This is in line with the approach favored by Nancy Polikoff, who hasn’t written about it yet but, I would guess, probably will soon: it makes marriage as a cultural formalism matter less, and instead tries to do a better job of accommodating what patients’ lives are actually like.

So I’m very glad to see this — although I’m still not extending much credit, this is an excellent move, and I’d like to hope that it’s the start of better things to come.

Update: Sure enough, Dr. Polikoff has a post up now about the memo.