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Only if you can't make them yourself (like you're in a coma) and you have the ability to give anyone else you want a medical, financial, or both power of attorney for those decisions. The default is your spouse only if you don't have a POA set up. It can be done with a signature and a notary. You can print out the documents for free and have it all done in 15 minutes. Your bank will notarize things for you for free. Otherwise it may cost you like $10.
So, when you're in your coma, how do you tell the hospital that your POA exists?
You can let your medical insurance put it on file and so long as the hospital has your name, it will be known and they would contact your mom or sibling or whoever you made your POA. A hospital will see that information long before figuring out who your spouse you separated from is.