If you really wanted to, you could legally marry someone but sign a prenuptial agreement that denied all spousal benefits except a particular one that you are seeking (end-of-life decisions, for example). Though in that case, instead of going through with a marriage, you’re better off signing just a regular contract for the specific right. In fact, for all benefits of a marriage contract, you could sign a non-marriage contract and get pretty much all the same rights.
You could sign a non-marriage contract and get pretty much all the same rights if you wanted to. But legal marriage contracts are preferred because it’s a one-stop contract that doesn’t require any fuss about negotiating the terms. And it’s more bullet-proof if any third party wants to file suit against one of the spouses (“she gave me end-of-life rights”, for example).
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