A federal judge on Monday recognized the out-of-state marriage of a gay Ohio couple, granting a temporary restraining order as one of the men nears death.

Ohio has a constitutional amendment banning gay marriage; James Obergefell and John Arthur have been together for two decades and got married earlier this month in Maryland because Arthur has Lou Gehrig’s disease, and is expected to die within weeks.

U.S. District judge Timothy Black issued a temporary restraining order Monday,  recognizing Obergefell as Arthur’s spouse, and suggested that failing to recognize the couple’s out-of-state union violated their rights to equal protection under the U.S. Constitution.

“This is not a complicated case,” Black wrote. “The issue is whether the State of Ohio can discriminate against same sex marriages lawfully solemnized out of state, when Ohio law has historically and unambiguously provided that the validity of a marriage is determined by whether it complies with the law of the jurisdiction where it was celebrated.”

While the ruling is temporary and limited to Obergefell and Arthur, the case could ultimately have broader implications. The court will hold a more extensive briefing on the issue in the future, noted Camilla Taylor, Lambda Legal’s marriage project director, and any final ruling could be appealed to the U.S. Court of Appeals for the Sixth Circuit and ultimately, the U.S. Supreme Court.

“This is particularly tragic and compelling case and it shows to all of us in the country, not just those of us who are gay or those of us who are in the judiciary, but to all Americans, the degree of commitment shown by many gay couples and their desire to take care of each other in the worst time of life that any of us can imagine,” Taylor said.

The case not only sends a powerful message, Taylor said, but she said Black’s “reasoning is sound” and could form the basis for a broader challenge to state bans on same-sex marriage: “This decision foreshadows what will happen to marriage bans across the country.”

In practical terms, the ruling will allow Obergefell’s name to be added to the death certificate as Arthur’s surviving spouse, give him access to federal and state benefits, and allow him to be buried next to Arthur in his family cemetery where the plot is restricted to direct descendants and spouses.

“This is yet another example of an activist federal judge substituting his views for those of the people. The people of Ohio have determined through overwhelmingly enacting their state marriage amendment that marriage is the union of one man and one woman, and the federal government must respect that decision,” said Frank Schubert, national political director for the National Organization for Marriage.