When do political issues become medical issues?

And I'm not even talking about health plans here. I'll leave aside for a moment tax credits vs. Medicare-for-all vs. universal employer coverage (which, by the way, still isn't analogous to universal coverage). I'm thinking specifically about the recent outcomes of Prop 8 in California (to ban same-sex couples from getting married), and of the Arkansas vote to prevent unmarried couples, gay or straight, from adopting children.
Now, you might say it's a good thing for children to be raised in intact homes. That's true. There are, however, intact and loving homes that haven't been marked with the state's official seal of approval (ie, a marriage license). Add to that the fact that the parents in some intact and loving homes, by virtue of legislation like Proposition 8 in CA, can NEVER become married--and the fact that various agency representatives in AR have said they basically intend to look the other way on the marriage issue "as long as they ain't queers or nothin'" (OK, so I've dramatized a bit) and you have a message of hate masquerading as concern for child welfare, which makes an already regrettable attitude downright despicable.
Am I saying this on account of the fact that I--at some point in my adolescence--'caught the gay?' Well, yeah, in part. But I'm also saying it because I know gay parents who have only managed to be legally recognized as the parents of their offspring through processes like second-parent adoption, and this sort of law threatens the ability of my tribe to create families. So what's second-parent adoption, you ask? Essentially, Mary and Alice are a couple. Mary gets artificially inseminated, maybe with Alice's egg to make the experience more equally 'shared'--but also a damned sight more confusing. So, Mary gives birth to the baby and is thus listed on the birth certificate. But, lo and behold, there's only space for one parent of each sex on the birth certificate, so Alice is S.O.L. until she secures a second-parent adoption, which establishes her as another mother. OK, I lied, it's not actually that confusing--just frustrating and lame.

So let's say (Goddess forbid) something happens to Mary, and there's no adoption, and no marriage. Well, if Mary listed Alice as the child's next guardian, it's all OK (well, not really, because if Mary's parents don't like it, they can contest it in court and in Arkansas chances are they'd win) and the right person ends up with the kid. But if Mary hasn't made a will? If she hasn't been thinking about her mortality, if her death wasn't anticipated, and she accidentally steps out in front of the 29 bus some morning? It would be nice to say that Alice, as the child's de facto other mother, would automatically get custody...but it would only be nice to say, because it wouldn't be true. Mary and Junior are both injured in a car accident and both incapacitated? Guess what--if they live in the wrong state and Alice hasn't officially been invested with healthcare decision-making power for her partner, Alice can't legally make medical decisions for either one of them.

That's when political issues become medical issues, and why a physician with the best interest of the patient at heart must be aware of both.