By ordering hospitals that take Medicare or Medicaid money to allow patients to be visited and helped by whomever they want, President Obama was taking a shot at those that have resisted the wishes often recorded in advance directives.
The presidential memo specifically notes the challenges for gay and lesbian people whose partners have sometimes been unable to act as legal surrogates.
Many hospitals already have broadened the categories of people permitted to visit or aid a hospitalized person. And some states, including North Carolina, have patient bills of rights that give the hospitalized person the power to say who's OK to visit.
But there's also been some backsliding on advance directives, too. Barbara Coombs Lee, president of Compassion & Choices, a patient advocacy group, talked with NPR's Julie Rovner about problems in some states, such as Idaho, where conscience provisions allow health workers who disagree with a patients' treatment choices to ignore them:
Similarly, late last year the U.S. Conference of Catholic Bishops made the use of feeding tubes for patients nearing the end of their lives more likely, even when people had specified beforehand that they didn't want them.
Dr. Jason Schneider, former president of the Gay and Lesbian Medical Association, told NPR's Ari Shapiro that unless a hospital has a formal policy allowing same-sex visitations, gay couples can run into trouble. Same goes when it comes to who can be a surrogate decision maker for an incapacitated person.
The president's order will take time to implement in federal regulations. But advocates hailed the decision. Some say the New York Times' reporting on the case of a same-sex couple in Florida helped push things along. Despite having power of attorney, a woman was unable to see her partner before she died of an aneurysm in 2007.