nl en

Beyond the Boundaries of Health Care


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.

Key words:

Skills: Teamwork, presentation, ethical analysis, policy brief.

Topic: Multidisciplinary approach of health care limits.

Disciplines: Medicine, ethics, political science/public administration, sociology.


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 nine interdisciplinary issues 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 will be challenged not only to acquire knowledge on contemporary healthcare issues, 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 in a group on one of the ‘limits’ threatening healthcare.

Course objectives:

Upon successful completion of this course, students:

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

  • can explain how limits in healthcare impact the practice of (medical, governance and other) professionals;

  • can perform an ethical analysis on a healthcare limit issue;

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

Programme and timetable:

Course meetings will take place on Wednesday evenings, from 18.00-20.30hrs
1. 16 October 2019
2. 23 October 2019
3. 30 October 2019
4. 6 November 2019
5. 13 November 2019
6. 20 November 2019
7. 27 November 2019
8. 4 December 2019
9. 11 December 2019
10. 18 December 2019

The program will look as follows:
1. Limitless Professions and Limited Professionals: The Actors of Healthcare
2. Affordable Healthcare: Healthcare Systems and Financial Boundaries, including a guest lecture by Dr. Sjaak Wijma, President of the National Health Care Institute
3. Being Mortal: Boundaries to Life, including a guest lecture by Dr. Dorothea Touwen, Assistant Professor Ethics and Law at Leiden University Medical Centre, specialist in ethical dilemmas of euthanasia
4. Limitless Technologies: What to do (and what NOT to do) when everything is possible?, including a skills workshop on how to write an ethical analysis
5. Policy and Professionals: The Boundaries of Regulation, including a separate skills workshop 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)
6. Where does the Patient end and the Human begin?
7. Active Citizenship: Responsibilities of the State and the Individual
8. Borders: Migration and Global Health, including a guest lecture by Dr. Min J Cho, Assistant Professor at Leiden University College with an expertise in global health and international development
9. Boundaries of Solidarity. including a guest lecture by Dr. Annelien Bredenoord, Professor of Ethics in Biomedical Innovation at Utrecht Medical Centre and member of the Dutch Senate
10. Beyond the Boundaries of Healthcare: Final Session, presentations of final project


Course meetings will take place at the Leiden University Medical Centre (LUMC), except for the final course meeting:
1. J1-116_route-554
2. J1-128_route-554
3. J1-116_route-554
4. J1-116_route-554
5. J1-116_route-554
6. J1-128_route-554
7. J1-116_route-554
8. J1-116_route-554
9. J1-116_route-554
10. Old Observatory room c003, Honours Academy building, not LUMC (exact location to be announced)

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.

  • 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 Blackboard.

Course load and teaching method:

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

  • Seminars: 10 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 essay: • Ethical analysis: 10 hours • Policy brief: 40 hours (teams of 3-4 students) • Final presentation policy brief: 6 hours

Assessment methods:

The assessment methods will look as follows:

  • 15% Participation assessed continually through participation in seminars (including the practical work assignment, that is preparation of one of the sessions by a team of 2-3 students)

  • 20% Ethical analysis on one of the ‘boundaries of health care’

  • 15% 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.
Please note: Attendance is mandatory.


Blackboard will be used in this course. Students can register for the Blackboard page one weeks prior to the start of the course.

Registration process:

Enrolling in this course is possible from Monday the 19th of August up to and including Thursday the 5th of September until 23:59 hrs through the Honours Academy. The registration link will be posted on the student website of the Honours Academy.

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