Social Protection in Neurodegenerative and Highly Complex Diseases: A Critical Analysis of an Emerging Legal Response

Abstract

Law 3/2024, enacted to improve the quality of life of individuals with amyotrophic lateral sclerosis (ALS) and other irreversible and highly complex diseases, represents a landmark statute born of the social mobilization of patients and associations. In this way, what was initially a diffuse interest –the dignity of those affected and their right to adequate care– is elevated to the category of an enforceable right with a supra-individual dimension.

This study is organized according to the systematic structure of the statute. It begins with an analysis of its scope of application, which combines immediate effectiveness for ALS with a conditional extension to other irreversible diseases. This normative design produces an asymmetric legal framework, one that is controversial from the standpoint of legal certainty and equity. The discussion then turns to the three basic pillars of the protection system: disability, with advances in automatic recognition and review; dependency, where an automatism linked to diagnosis is introduced; and permanent incapacity, where access has been made more flexible. Each section examines both the legislative advances and, in particular, the doctrinal limitations of the statutory design. Finally, the study considers the practical difficulties arising from the administrative and judicial implementation of the statute, which decisively shape the real effectiveness of reforms whose legal force nonetheless coexists with the fragility of their implementation.