By any means. Joyner notes this paragraph in the Obama memo:
Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf.
And makes an important observation:
[It] sounds like Obama is ordering a very broad right of hospital visitors to designate whomever they wish be allowed to visit and carry out medical decisions. This will have a disparate impact on homosexuals, of course, but it bypasses the “special rights” argument that opponents of gay rights typically cite. And they’d have a point in this case were Obama to privilege homosexual couples over non-married heterosexual couples.
If my interpretation of what Obama is doing is correct, then I wholeheartedly support the policy outcome. It’s long past due.
I fear it's a way to tell gays they cannot marry. The Democrats will say: see, you can already have hospital visitation rights. Now please stop alienating people with all this civil rights talk. And the Human Rights Campaign can last a thousand years mediating these morsels of compassion from the executive branch. I favor the right to designate anyone in advance as your next of kin in hospital. But for gays, I favor merely the same rights as straights. Which means to say: no more and no less than civil marriage.