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One step at a time

Most people would never question the right of a parent to visit a sick child in the hospital or the appropriateness of a spouse making medical decisions for a critically ill partner. Such emergency interventions are a normal part of life, something expected of loving caretakers — unless they happen to be gay or lesbian. Then hospitals, nursing homes and ambulance companies can routinely deny patients the comfort of a loved one's presence, even when issues of life and death hang in the balance.

Last week President Barack Obama moved to correct that injustice when he ordered the U.S. Department of Health and Human Services to prohibit Medicare and Medicaid payments to hospitals that discriminate against same-sex couples by only recognizing the visitation rights of legal spouses and blood relatives. The order would also require hospitals to respect patients' choices about who may make critical health-care decisions for them, a right often denied to same-sex couples.

President Obama in effect delivered these rights to gays and lesbians with a stroke of his pen, since the order doesn't require congressional approval and is unlikely to be challenged in the courts. The vast majority of the nation's health-care institutions already accept Medicare and Medicaid reimbursements, so most will simply adopt the new policy without protest. By such means, the president deftly sidestepped opponents of equal rights for gays and lesbians, and without provoking a fight with lawmakers or reigniting the culture wars.

To Maryland's credit, same-sex couples here have enjoyed the protections Mr. Obama extended to the rest of the nation since 2007, when Gov. Martin O'Malley signed a similar package of provisions recognizing visitation and other rights for same-sex couples. The biggest difference will be what happens when those couples leave the state for any reason. They now can be confident that if a medical emergency presents itself during a vacation or a brief trip beyond Maryland's borders, they will still be entitled to care for their loved ones and make medical decisions about their treatment wherever they are.

Mr. Obama has been under considerable pressure from gay rights advocates to move more quickly to advance the cause of equal rights for same-sex couples and individuals. The president's strategy has been to respond with a series of individually modest, relatively uncontroversial steps whose cumulative effect is the expansion of gay and lesbian rights and the gradual reshaping of government policies on their behalf.

Since taking office, for example, the president has signed off on several measures that benefit gays and lesbians, including extending some federal benefits to same-sex partners of federal workers; prodded the military to repeal its "don't ask, don't tell" policy banning gays from serving openly in the armed forces — a longtime goal that seems all but certain now to be achieved — and signed a hate crimes law that explicitly protects gays from attacks motivated by bias based on sexual orientation or gender identification. In a more symbolic vein, he has also invited gay parents to attend the White House Easter egg hunt and awarded the Presidential Medal of Freedom posthumously to slain San Francisco Board of Supervisors member Harvey Milk, who in 1977 became the first openly gay man elected to public office in California.

While these steps may not satisfy advocates' demands for bold, immediate action over the whole range of issues important to gays and lesbians, Mr. Obama's incremental, pragmatic approach seems to be working precisely because it doesn't stray too far from the political center and because the issues are presented in a framework that both liberal supporters and conservative opponents find hard to attack. The order on gay hospital visitation rights, for example, was couched in such gender-neutral terms that it could encompass the situation of a distant relative or even a workplace acquaintance if a patient so chose.

Mr. Obama thus is making good on his pledge to back equal rights for gays and lesbians. But instead of the single giant leap some had hoped for, he is advancing the cause through a multitude of smaller steps, each one calculated to bring the goal of equal rights for gays and lesbians a step closer to being achieved.

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