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Beyond the Boundaries of Healthcare


Topics: Multidisciplinary perspective on the limits of healthcare.
Disciplines: Medicine, ethics, political science, public administration.
Skills: Teamwork, presentation, ethical analysis, policy brief.

Admission requirements:

This course is an (extracurricular) Honours Class: an elective course within the Honours College programme. Third year students who don’t participate in the Honours College, have the opportunity to apply for a Bachelor Honours Class. Students will be selected based on i.a. their motivation and average grade.


The achievements of modern healthcare seem limitless. Indeed, the dramatic increase in average life expectancy during the 20th century and the cure of many diseases by new technology and medicines can be said to be one of society’s greatest achievements. At the same time we are faced with the limits of healthcare in multiple ways. As societies grow more culturally diverse, will we maintain enough societal and political support for basic health insurance? Can doctors still perform their job when they are plagued by high administrative burdens? In an ageing society, is there a way to make healthcare financially sustainable? This course will confront students with these and other limits of healthcare and look beyond the boundaries of disciplines to offer a more nuanced view of contemporary healthcare issues. This is important as healthcare is a complex sector in which not only pure facts, but emotions and normative perspectives play a hugely important role – on the level of the patient-doctor relationship, but also on macro-level governance and in political debates.

Throughout this course a total of eight interdisciplinary issues in ten sessions concerning the limits of healthcare will be discussed. Theory and practice will be connected in all the course meetings by interesting guest speakers and an excursion, but also by the students themselves! Each week a different team of students will prepare the session by collecting interesting practical insights. We will consistently connect the limits of health care to the work of the doctor, civil servant, or other type of professional that students are studying to become. Students are free to discuss the topics on the basis of the COVID-19 pandemic.

Students will be challenged not only to acquire knowledge on contemporary healthcare issues (such as COVID-19, prevention, ageing, technology), but also to look at these issues from different angles using skills and methods from different disciplines. Most notably students will learn from the ethics approach and write a short ethical analysis on a normative healthcare issue. For the final assignment students will be taught public administration skills and deliver a policy brief prepared on one of the ‘limits’ threatening healthcare.

Course objectives:

Upon successful completion of this course, students will be able to:

  • Explain the multifaceted role of healthcare in society by connecting normative and governance perspectives to (medical) care issues;

  • Apply knowledge of the limits in healthcare to the practice of (medical, governance and other) professionals;

  • Analyse an ethical healthcare issue;

  • Create and present a policy brief on one of the limits facing healthcare.

Programme and timetable:

The sessions of this class will take place from 17.30 - 20.00 on the following Tuesdays:

Session 1: February 6
Introduction to Wicked Healthcare: Complex problems, different societal views and various actors. The micro, meso and macro levels of health governance

Session 2: February 13
Limitless Technologies: What to do (and what NOT to do) when everything is possible?

Session 3: February 20
Being Mortal: Boundaries to Life

Session 4: February 27
Healthcare Governance: Dilemma’s between accessibility, quality and affordability

Session 5: March 5
Policy and Professionals: The Boundaries of Regulation combined with an excursion (date to be announced) on how to write a policy brief at the Ministry of Health, Welfare and Sports (VWS) / Council for Health and Society (Raad voor Volksgezondheid en Samenleving)

Session 6: March 12
Where does the Patient end and the Human begin?

Session 7: March 19
Active Citizenship: Responsibilities of the State and the Individual

Session 8: March 26
Borders: Migration and Global Health

Session 9: April 2
Boundaries of Solidarity

Session 10: April 9
Beyond the Boundaries of Healthcare: Final Session, presentations of final project

Guest lecturers will be invited to speak in several seminars.

Leiden University Medical Centre (LUMC), room J1-116

Reading list:

  • Gawande, A. (2014). Being Mortal: Medicine and What Matters in the End. New York: Metropolitan Books, Henry Holt and Company.

  • Huber, M. et al. (2011). How should we define health? British Medical Journal, 343, d4163.

  • Riasio, H., Puustinen, A., & Vartiainen, P. (2018). The Concept of Wicked Problems: Improving the Understanding of Managing Problem Wickedness in Health and Social Care. In Thomas, W., Hujala, A., Laulainen, S., & McMurray, R. (Eds.), The Management of Wicked Problems in Health and Social Care. Routledge.

  • Simpkin, A., & Schwartzstein, R. (2016). Tolerating Uncertainty – The Next Medical Revolution? The New England Journal of Medicine, 375(18), 1713-1715.

This reading list gives an impression of the literature we will read for this course. The definitive reading list with mandatory and recommended literature will be announced via Brightspace.

Course load and teaching method:

This course is worth 5 ECTS, which means the total course load equals 140 hours.

  • Seminars: 9 seminars of 2,5 hours

  • Excursion: 1 excursion of 3 hours

  • Literature reading: 5 hours/week

  • Practical work: 6 hours (preparation for one session in teams of 2-3 students)

  • Assignments & final presentation:

  • Ethical analysis: 10 hours

  • Policy brief: 40 hours (teams of 3-4 students)

  • Final presentation policy brief: 8,5 hours

Assessment methods:

  • 20% Participation assessed continually through participation in seminars (including the practical work assignment via different working forms/multimedia resources, that is preparation of one of the sessions by a team of 2-3 students)

  • 10% Ethical analysis on one of the ‘boundaries of health care’ in preparation for the policy brief

  • 20% Presentation of the policy brief

  • 50% Policy brief (teams of 3-4 students)

Students can only pass this course after successful completion of all partial exams. This entire course is eventually graded with a pass or fail.
Please note: Attendance is mandatory.

The assessment methods will be further explained in the first session of the class.

Brightspace and uSis:

Brightspace will be used in this course. Upon admission students will be enrolled in Brightspace by the teaching administration.

Please note: students are not required to register through uSis for the Bachelor Honours Classes. Your registration will be done centrally.

Application process:

Submitting an application for this course is possible from Monday 30 October up to and including Sunday 19 November 2023 23:59 through the link on the Honours Academy student website.

Note: students don’t have to register for the Bachelor Honours Classes in uSis. The registration is done centrally before the start of the class.