Moral purism is a commonly held view on moral worthiness and how to identify it in concrete cases. Moral purists long for a moral world in which (business) people—at least sometimes—act morally worthy, but in concrete cases they systematically discount good deeds as grounded in self-interest. Moral purism evokes moral cynicism. Moral cynicism is a problem, both in society at large and the business world. Moral cynicism can be fought by refuting moral purism. This article takes issue with moral purism. (...) The common strategy to tackle moral purism is to reject the exclusion thesis which states that self-interest and the ‘pure’ moral motive (and thus moral worthiness) exclude each other. We develop a different strategy. We argue that moral purists are mistaken in the way they judge moral worthiness in concrete cases. They employ the wrongprocedureand the wrongcriteria.We develop a proper procedure and proper criteria. We build on Kant, who we argue is unfairly regarded as the champion of moral purism. In order to see how Kant can develop a consistent (non-purist) philosophy, the exclusion thesis must be embedded in Kant’s transcendental philosophy. Properly embedded, Kant turns out to be both anti-purist and anti-cynical. (shrink)

For years business ethics has limited the moral duties of enterprises to negative duties. Over the last decade it has been argued that positive duties also befall commercial agents, at least when confronted with large scale public problems and when governments fail. The argument that enterprises have positive duties is often grounded in the political nature of commercial life. It is argued that agents must sometimes take over governmental responsibilities. The German republican tradition argues along these lines as does Nien-Hé (...) Hsieh. Agents in commercial life are bound by positive duties because at some point they become citizens that must take on the responsibilities of the state. In this paper we leave undisputed the claim that corporations must acknowledge positive duties. However, we demonstrate that the political grounding fails, at least in the sense that this theory insufficiently acknowledges a long standing liberal tradition that vindicates apolitical markets and clear borderlines between politics and economics. We carve out an alternative route to the grounding of one specific positive duty—the duty to further justice. Our argument is based on the moral nature of commercial agents and tries to demonstrate that the duty to further justice ensues from liberalism. Taking a Kantian perspective, it conceptualizes the duty to further justice as a moral duty, orientated toward the political domain. It is grounded in the obligation to attain moral autonomy in the civil condition. (shrink)

This paper provides an empirical case study of the relationship between corporate social responsibility (CSR) and the new competition regulation in the Netherlands. The leading question in this case study is whether the new institutional arrangement has allowed for the possibility that reasonable exceptions can be made to the principle that inter-firm cooperation is prohibited. That is to say: does the new institutional arrangement allow for the possibility of 'well organized but not 'perfect' markets'? The investigation focuses on the Netherlands, (...) which constitutes an exemplary case as the Dutch are committed to both strengthen the competitiveness of the market and allow for exceptions on behalf of non-economic values such as CSR. The authors expect that the Dutch context will prevent a doctrinal and categorical rejecting of any good argument to make an exception to the rule that inter-firm cooperation must be prohibited. (shrink)

In latter-day discussions on corporate morality, duties of commission are fiercely debated. Moral institutionalists argue that duties of commission—such as a duty of assistance—overstep the boundaries of moral duty owed by economic agents. " Moral institutionalism" is a newly coined term for a familiar position on market morality. It maintains that market morality ought to be restricted, excluding all duties of commission. Neo-Classical thinkers such as Baumol and Homann defend it most eloquently. They underpin their position with concerns that go (...) to the core of liberalism—the dominant western political theory that sustains the ideals of both the free market and the free, rational person. Those authors claim that liberalism calls for a fully differentiated market because it resents the politicization of the market. Fully differentiated markets exclude duties of commission. They also claim that full differentiation of the market closes the troublesome gap between moral motivation and moral virtue. Full differentiation redeems the promise of "easy virtue". In this paper moral institutionalism will be rejected from a Kantian point of view, mostly inspired by Herman's thesis on the invisibility of morality. Liberalism may perhaps ban the politicization of the market; it does not forbid its moralization. The idea of a fully differentiated market must also be rejected because it is either morally over-demanding (to the morally autonomous person) or morally hazardous (to the person with failing moral motivation). Contrary to what the moral institutionalists claim, right action, morally, is actually quite difficult in fully differentiated markets. (shrink)

One of the essential parts within the transition towards sustainable economies, is the way how higher education prepares its students for their future role in business. In order for them to contribute to corporate social responsibility within the enterprise context, they need specific skills and competences related to sustainable development. Derived from the societal role of business schools in preparing the future business leaders and entrepreneurs, the focus of this paper is the participation in, and the contribution of business schools (...) to the issues of efficiency measures for sustainability. This topic could be wider situated within the context of higher education for sustainable development, which aims at integrating competences for sustainable development into the curriculum, and integrating sustainability measures within campus operations, research and societal role. The paper furthermore looks at a business school context as a case for institutional efficiency measures. The paper describes how business schools could implement efficiency measures and apply instruments within their own context, looking at the campus as a ‘living laboratory’ for sustainability innovation. The paper describes how tools and instruments to foster sustainability integration are applied on campus, its benefits and possible problems. The paper focuses on the application of three instruments: Assessment Instrument for Sustainability in Higher Education; Ecological Footprint Analysis; and Principles for Responsible Management Education. It builds upon the data and results from several action research projects within two Belgian business schools. As a conclusion, the paper will reflect upon the essential characteristics of these initiatives, as a way to enhance efficiency measures for sustainability both within the business school itself, as within a wider business context. (shrink)

Ecological footprint analysis has been used worldwide in a variety of organizations educational institutions) and at different levels organizations, cities, regions, countries). Universities also calculated their ecological footprints, for various reasons: e.g. to answer the societal appeal to integrate sustainability into their core business, to perform a sustainability assessment of their operations, to use as an educational tool with students, to use for policy development. In general, performing an ecological footprint analysis is a way for higher education to ‘practice what (...) they preach’, to monitor sustainability performance and raise awareness among the university's community. This article focuses on the calculation of the ecological footprint and discusses the possibilities to use this tool for campus operations, educational purposes and policy development. (shrink)

This chapter deals with the question to what extent market participants can have moral responsibilities. It starts with a discussion on the nature of responsibility, and then raises the question whether organizations, such as companies can bear responsibility (at all). While some philosophers have been skeptical, we list some reasons to think that companies can be moral agents. Subsequently, we discuss whether companies actually should assume moral responsibilities. There are a number of commonly heard arguments about why companies should or (...) may not be bothered with moral responsibilities: i. the market is an amoral sphere, and ii. the only responsibility that companies have is to increase their profits. We describe the problems with these arguments, and discuss the concept of minimal market morality. This concept describes the minimally required moral responsibilities that companies need to abide by. (shrink)

Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue that doctor and (...) patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD. (shrink)

'Corporate Social Responsibility (CSR) is conceptualized in many ways. We argue that one cannot be indifferent about the issue of its conceptualization. In terms of methodology, our position is that any conceptual discussion must embed CSR in political theory. With regard to substance, we link up with the discussion on whether CSR must be defined on the basis of a tripartite or a quadripartite division of business responsibilities. We share A. B. Carroll's intuition that a quadripartite division is called for (...) as a basis to define CSR. However, defending the quadripartite division of business responsibilities requires that the distinctions between economic, legal, ethical and discretionary business responsibilities be made intelligible. Carroll's account is defective in this respect. We argue that contemporary Neo-Kantian political ethics is able to make sense of these distinctions, because of its specific interpretation of liberalism. Interestingly, from a conventional liberal perspective this interpretation of liberalism is atypical, as it extends public morality beyond the domain of the law. (shrink)

One of the most interesting and entertaining philosophical discussions of the last few decades is the discussion between Daniel Dennett and John Searle on the existence of intrinsic intentionality. Dennett denies the existence of phenomena with intrinsic intentionality. Searle, however, is convinced that some mental phenomena exhibit intrinsic intentionality. According to me, this discussion has been obscured by some serious misunderstandings with regard to the concept ‘intrinsic intentionality’. For instance, most philosophers fail to realize that it is possible that the (...) intentionality of a phenomenon is partly intrinsic and partly observer relative. Moreover, many philosophers are mixing up the concepts ‘original intentionality’ and ‘intrinsic intentionality’. In fact, there is, in the philosophical literature, no strict and unambiguous definition of the concept ‘intrinsic intentionality’. In this article, I will try to remedy this. I will also try to give strict and unambiguous definitions of the concepts ‘observer relative intentionality’, ‘original intentionality’, and ‘derived intentionality’. These definitions will be used for an examination of the intentionality of formal mathematical systems. In conclusion, I will make a comparison between the (intrinsic) intentionality of formal mathematical systems on the one hand, and the (intrinsic) intentionality of human beings on the other hand. (shrink)

As Socially Responsible Investment (SRI) enters the mainstream of professional and institutional investment practice, some perplexities arise. Some SRI market participants are well schooled in finance but are hesitative as to how to apply non-financial criteria in the management of portfolios. Governments too are giving SRI more attention and, in some countries, are discussion whether and how to regulate the SRI market. Advocacy groups are targeting SRI projects through media campaigns using political discourse. Many of the pertinent questions that come (...) with these perplexities are of the philosophical or ethical type and concern legitimisation, demarcation of responsibilities, interpretation of norms and policy formulation. The inclusion of non-financial criteria into investment decision-making leads to a 'puzzle in SRI' for which this article offers a solution. The puzzle arises when the day-to-day implementation of an SRIpolicy coincides with the process of administering justice. Three questions make up that puzzle: (1) what should an investor do when allegations arise about a corporation, (2) what should an investor do when a corporation is brought before a court, (3) what should an investor do when a corporation is found guilty by a court. This article argues, by distinguishing between the rationality of the investor and that of the judge, that allegations, court cases or court verdicts should not be reasons to disinvest from a corporation. This article offers examples from investor practice and points out in which way allegations, court cases and court verdicts make sense for investor behaviour. (shrink)

Research regarding the drivers of acceptance of clinical decision support systems by physicians is still rather limited. The literature that does exist, however, tends to focus on problems regarding the user-friendliness of CDSS. We have performed a thematic analysis of 24 interviews with physicians concerning specific clinical case vignettes, in order to explore their underlying opinions and attitudes regarding the introduction of CDSS in clinical practice, to allow a more in-depth analysis of factors underlying acceptance of CDSS. We identified three (...) general themes from the results. First, ‘the perceived role of the AI’, including items referring to the tasks that may properly be assigned to the CDSS according to the respondents. Second, ‘the perceived role of the physician’, referring to the aspects of clinical practice that were seen as being fundamentally ‘human’ or non-automatable. Third, ‘concerns regarding AI’, including items referring to more general issues that were raised by the respondents regarding the introduction of CDSS in general and/or in clinical medicine in particular. Apart from the overall concerns expressed by the respondents regarding user-friendliness, we will explain how our results indicate that our respondents were primarily occupied by distinguishing between parts of their job that should be automated and aspects that should be kept in human hands. We refer to this distinction as ‘the division of clinical labor.’ This division is not based on knowledge regarding AI or medicine, but rather on which parts of a physician’s job were seen by the respondents as being central to who they are as physicians and as human beings. Often the respondents’ view that certain core parts of their job ought to be shielded from automation was closely linked to claims concerning the uniqueness of medicine as a domain. Finally, although almost all respondents claimed that they highly value their final responsibility, a closer investigation of this concept suggests that their view of ‘final responsibility’ was not that demanding after all. (shrink)

Many prominent arguments for epistemic relativism take their departure from the observation that a certain kind of epistemic symmetry is present in particular empirical cases. In this paper, we seek to attain further clarity about the kind of symmetry at issue, and the sort of relativism to which such symmetry can reasonably be taken to give rise. The need for such an investigation is made apparent, we believe, by the fact that prominent anti-relativist arguments such as that advanced by Boghossian (...) in his influential book Fear of Knowledge (2006) yield distorted pictures of the matter. Following Boghossian, we present our argument through a detailed consideration of the dispute between Bellarmine and Galileo concerning heliocentrism. Contrary to what Boghossian claims, the relevant sort of symmetry does not concern a difference in fundamental epistemic principles between Bellarmine and Galileo, but rather a much more localized difference in procedures for adjudication between shared principles in the novel epistemic circumstances generated by Galileo's telescopic observations. Bellarmine and Galileo advance fundamentally different procedures of adjudication that are nevertheless equally rational. The upshot is not so much the denial that there are absolute epistemic facts as such, as Boghossian thinks, but rather the denial that there is an absolute fact of the matter as to which was the most rational way to proceed: Bellarmine's or Galileo's. What this gives us, is the denial that there is a certain kind of absolute epistemic fact. (shrink)

Several attempts to conceptualize farm animal welfare have been criticized for diverging reasons, among them often the failure to incorporate the public concern and opinion. This paper’s objective is to develop a conception of farm animal welfare that starts from the public’s perception and integrates the opinion of different stakeholder representatives, thus following a fork-to-farm approach. Four qualitative citizen focus group discussions were used to develop a quantitative questionnaire, which has been completed by a representative sample of Flemish citizens ( (...) n = 459). Exploratory and confirmatory factor analyses were applied to develop a conception of farm animal welfare starting from an extended list of aspects that relate to animal production and associate with farm animal welfare in the public’s perception. In depth interviews with stakeholder representatives were used to match and adapt the structure of the animal welfare conception model. The resulting conception revealed seven dimensions grouped in two different levels. Three dimensions were animal-based: “Suffering and Stress,” “Ability to Engage in Natural Behavior,” and “Animal Health.” Four dimensions were resource-based: “Housing and Barn climate,” “Transport and Slaughter,” “Feed and Water,” and “Human-Animal Relationship.” This conception is distinct from earlier attempts since it is based on public perceptions; it addresses the opinion of different stakeholders, and it distinguishes empirically between animal-based and resource-based dimensions in the conceptualization of farm animal welfare. The relevancy of a popular definition is supported by the present demand oriented economy, in which animal welfare is a non-trade concern, and mainly left to the market where consumers still mainly act as individuals who calculate and weigh pros and cons. (shrink)

Socially Responsible Investment (SRI) has grown considerably over the past three decades. One form of SRI, engagement-SRI, is today by far the most practiced form of SRI (in assets managed) and has the potential to mainstream SRI even further. However, lack of formalized engagement procedures and evaluation tools leave the engagement practice too opaque for such a mainstreaming. This article can be considered as a first step in the development of a standard for the engagement practice. By developing an engagement (...) heuristic, this article offers a more transparent engagement dialog. Drawing on Stevenson's and Austin's speech-act theories, this article develops a classification of management's responses to the signaling of allegations and controversies on two dimensions: a factual dimension concerning (dis)agreements on factual claims and an attitudinal dimension concerning (dis)agreements on responsibilities, values, and norms. On the basis of the distinctions this article develops, the authors provide for a synoptic table and offer a next-step heuristic for the engagement process that started with signaling a concern to management. The article uses an engagement logic that, while keeping the exit option for the investor open, allows management to address signaled concerns without having to let down or to opt out at the first setback in the dialog process between investor and investee corporation. (shrink)

Transparency is a crucial condition to implement a CSR policy based on the reputation mechanism. The central question of this contribution is how a transparency policy ought to be organised in order to enhance the CSR behaviour of companies. Governments endorsing CSR as a new means of governance have different strategies to foster CSR transparency. In this paper we discuss the advantages and disadvantages of two conventional policy strategies: the facilitation policy and the command and control strategy. Using three criteria (...) (efficiency, freedom and virtue) we conclude that both strategies are defective. Most attention is paid to the facilitation strategy since governments nowadays mainly use this. In evaluating this strategy we analyse the Dutch case. As an alternative we introduce a third government policy: the development of a self-regulating sub-system. By construing an analogy with the historical development of corporate financial disclosure, we point out that the vital step in the creation of a self-regulating subsystem is the creation of strong informational intermediate organisations. (shrink)

As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like. Building on an interview study of researchers’ practices and perspectives, we identified key considerations for the set-up of pathways for the detection, management and communication of (...) incidental findings in imaging research. We conducted an interview study with a purposive sample of researchers at research facilities across the Netherlands. Based on a qualitative analysis of these interviews and on existing guidelines found in the literature, we developed a prototype ethical framework, which was critically assessed and fine-tuned during a two-day international expert meeting with bioethicists and representatives from large population-based imaging studies from the United Kingdom, Germany, Sweden and Belgium. Practices and policies for the handling of incidental findings vary strongly across the Netherlands, ranging from no review of research scans and limited feedback to research participants, to routine review of scans and the arrangement of clinical follow-up. Respondents felt that researchers do not have a duty to actively look for incidental findings, but they do have a duty to act on findings, when detected. The principle of reciprocity featured prominently in our interviews and expert meeting. We present an ethical framework that may guide researchers and research ethics committees in the design and/or evaluation of appropriate pathways for the handling of incidental findings in imaging studies. The framework consists of seven steps: anticipation of findings, information provision and informed consent, scan acquisition, review of scans, consultation on detected abnormalities, communication of the finding, and further clinical management and follow-up of the research participant. Each of these steps represents a key decision to be made by researchers, which should be justified not only with reference to costs and/or logistical considerations, but also with reference to researchers’ moral obligations and the principle of reciprocity. (shrink)

Many authors have argued that the core of evolutionary biology as represented by the catchphrase 'The fittest survive' is tautological. Concerning the fitness concept of population genetics it is easy to rebut this charge by a proper explication of the term 'survival'. In biology and in the philosophy of biology, various fitness concepts over and above that of population genetics have been elaborated. These concepts, which are called 'supervenient' by some philosophers, have a limited usefulness. On some interpretations they do (...) lead to unacceptable tautologies and circular reasoning. The so-called propensity concept of fitness is problematic in this respect. If interpreted in a proper way, supervenient concepts appear not to allow the formulation of highly general explanations and theories; at best they reveal common patterns among diverse non-general explanations and theories. Philosophers cherishing supervenient fitness concepts are apparently motivated by a mistaken search for general theory. The fitness concept of population genetics may play a role in relatively general theories and explanations. Supervenient concepts cannot play such a role. They should rather help us recognize the value of natural history in biology. (shrink)

Science is not value-free and ethics is not fact-free. Science and ethics should be similar, but they are not. The author indicates how research in ethics is to change in the face of this. Ethicists should accommodate empirical work in their programs and they should take heed of methodologies developed in science and philosophy of science. They should abandon the search for a single overarching theory of morality. Controversies in ethics are often spurious for lack of articulate methodological key concepts. (...) For example, disagreements over the value of general theories are misguided since disputants implicitly use different notions of generality and different notions of theory. An appropriate methodology does not suffice for the resolution of controversies but it is indispensable for consensus. The book argues these theses in a general way and applies them to the subject of egoism and altruism in ethics. Further case studies concern the environment and psychiatric disorders. (shrink)

Legal and moral reasoning share much methodology, and they address similar problems. This volume charts two shared problems: the relation between theory, principles and particular judgments; and the role of facts and factual assertions in normative settings. The relation between 'theory' and 'practice' and between 'principle' and 'particular judgment' has become the subject of much debate in moral philosophy. In the ongoing debate, some moral philosophers refer to legal philosophy for a support of their views on the primacy of 'practice' (...) over 'theory'. According to them, legal philosophy should have a more balanced view in that relation. In the contributions to Part One this claim is critically analysed. The role of the facts is underestimated in discussions on legal reasoning and legal theory, as well as moral reasoning and ethical theory. Factual statements enter into moral and legal discussions not only because they link the conclusion with a rule. They also play a role as background assumptions in supporting a theory. Its focus on the role of facts in normative reasoning makes this book of special interest to scholars of legal and moral argumentation. (shrink)

The European Corporate Sustainability Framework (ECSF) is, among other concepts, based on a phase-wise development approach as described by Clare Graves' Levels of Existence Theory. As much as corporate sustainability has a sequence of adequate interpretations, aligned with each development level, also the notion of business excellence can be defined at multiple levels, as this paper demonstrates. Furthermore, the authors analyze the current EFQM Excellence Model for particular biases towards various development levels and suggest a new and innovative two-step approach (...) to assessing organizational performance with respect to organizational excellence (OE) and corporate sustainability. According to the organization's ambition, the assessment is either limited to a shareholder approach, mainly focusing at optimal usage of resources, or it also includes an additional assessment format based on the stakeholder approach, with specific reference to the organization's performance on the financial, social and ecological bottom line. This paper demonstrates the need and feasibility of an EFQM-Based assessment tool with a combined focus on corporate sustainability and OE. (shrink)

Over the past 20 years business ethics in Europe witnessed a remarkable growth. Today business ethics is faced with two challenges. The first comes from the social sciences and consultants who have both reclaimed the topics of business ethics, regretfully often at the loss of the proper ethical perspective. The second comes from the remarkable rise of corporate social responsibility which has pushed aside the mainstream business ethics methodology with its emphasis on moral deliberation by the individual. These challenges can (...) be tackled by an institutional transformation in business ethics that links up to the long-standing European tradition of institutional analysis of the market. The second remedy is an enlargement of the research agenda in business ethics by coming closer to other parts of applied ethics where the business ethics view is at this moment grossly neglected. (shrink)

The nature of unconscious information processing is a heavily debated issue in cognitive science, and neuroscience. Traditionally, it has been thought that unconscious cognitive processing is restricted to knowledge that is strongly prepared by conscious processes. In three experiments, we show that the task that is performed consciously can also be applied unconsciously to items outside the current task set. We found that a same–different judgment of two target stimuli was also performed on two subliminally presented prime stimuli. This was (...) true for target and prime stimuli from entirely different categories, as well as for prime and target stimuli at different levels of abstraction. These results reveal that unconscious processing can generalize more widely than previously accepted. (shrink)

One of the major criticisms of optimal foraging theory is that it is not testable. In discussions of this criticism opposing parties have confused methodological concepts and used meaningless biological concepts. In this paper we discuss such misunderstandings and show that OFr has an empirically testable, and even well-confirmed, general core theory. One of our main conclusions is that specific model testing should not be aimed at ‘proving’ optimality, but rather at identifying the context in which certain types of behaviour (...) are optimal. To do this, it is necessary to be aware of the assumptions made in testing a model. The assumptions that are explicitly stated in the literature up to now do not completely cover the actual assumptions made in testing OFT models in practice. We present a more comprehensive set of assumptions. Although all the assumptions play a role in testing models, they are not of equal status. Crucial assumptions concern constraints and the relation between fitness and currency. Therefore, it is essential to make such assumptions testable in practice. We show that a more explicit relationship between OFT modelling and evolutionary theory can help with this. Specifically, phylogeny reconstruction and population dynamic modelling can and should be used to formulate assumptions concerning constraints and currencies. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

The use of artificial intelligence (AI) in healthcare comes with opportunities but also numerous challenges. A specific challenge that remains underexplored is the lack of clear and distinct definitions of the concepts used in and/or produced by these algorithms, and how their real world meaning is translated into machine language and vice versa, how their output is understood by the end user. This “semantic” black box adds to the “mathematical” black box present in many AI systems in which the underlying (...) “reasoning” process is often opaque. In this way, whereas it is often claimed that the use of AI in medical applications will deliver “objective” information, the true relevance or meaning to the end‐user is frequently obscured. This is highly problematic as AI devices are used not only for diagnostic and decision support by healthcare professionals, but also can be used to deliver information to patients, for example to create visual aids for use in shared decision‐making. This paper provides an examination of the range and extent of this problem and its implications, on the basis of cases from the field of intensive care nephrology. We explore how the problematic terminology used in human communication about the detection, diagnosis, treatment, and prognosis of concepts of intensive care nephrology becomes a much more complicated affair when deployed in the form of algorithmic automation, with implications extending throughout clinical care, affecting norms and practices long considered fundamental to good clinical care. (shrink)