You can do paperwork for these things

Please explain to me how exactly could I "do paperwork" to restore, for example the spousal communications privilege and the spousal testimonial privilege that would both be taken away from me if my marriage was dissolved.

And do you really expect people to just start pre-emptively filling out paperwork to notify every single hospital they might possibly ever end up in after some major health issue, that would allow their spouse to visit them, particularly if it's a hospital in an area hostile to queer folks?