The Netherlands Journal of Critical Care (Neth. J. Crit. Care) recognizes the growing use of generative artificial intelligence (AI), large language models (LLMs), chatbots, AI-assisted writing tools, image-generation tools, and other AI technologies in research and scholarly publishing.

The journal follows the current recommendations of the International Committee of Medical Journal Editors (ICMJE) and relevant principles of responsible publication ethics. The current ICMJE Recommendations, updated in January 2026, include specific guidance for authors, reviewers, editors, and publishers regarding the responsible use of AI in medical publishing.

1. Human Responsibility

AI tools cannot assume responsibility for the accuracy, integrity, originality, ethical conduct, or accountability of scholarly work.

Therefore, human authors remain fully responsible for all content submitted to the journal, including any text, data, analyses, images, references, tables, figures, or other material produced or assisted by AI.

AI systems must not be listed as authors or co-authors because they cannot meet the responsibilities and accountability required for authorship.

2. Use of AI by Authors

Authors may use generative AI or AI-assisted technologies for appropriate purposes, such as:

• Language improvement and grammar correction
• Spelling and punctuation
• Improving clarity and readability
• Translation assistance
• Formatting or organizational assistance
• Certain research-support functions where scientifically appropriate

However, authors must carefully review all AI-generated or AI-assisted material because AI systems may produce inaccurate, incomplete, biased, fabricated, or misleading information.

Authors remain responsible for verifying all factual claims, references, data, interpretations, and conclusions before submission.

3. Disclosure of AI Use

Authors must disclose the use of AI-assisted technologies when such tools have contributed to the production of the submitted work.

The disclosure should identify:

• The AI tool or system used
• The purpose for which it was used
• The manner or stage in which it was used
• The relevant portion of the work affected by the AI tool, where appropriate

ICMJE recommends that authors disclose AI use in the cover letter and the submitted manuscript in an appropriate section, depending on the nature of the use. For example, AI used for writing assistance may be described in the acknowledgments, while AI used for data analysis or figure generation should be described in the relevant methods section.

4. AI-Generated Text

Authors may use AI tools for language assistance, but they must carefully review and edit the resulting text.

Authors are responsible for ensuring that AI-generated text:

• Is factually accurate
• Does not contain fabricated information
• Does not contain plagiarism
• Does not misrepresent the authors' research
• Does not improperly reproduce copyrighted material
• Contains appropriate citations and acknowledgments where required

AI-generated material must not be presented as independently verified scientific evidence.

5. AI-Generated References and Citations

Authors must independently verify all references generated or suggested by AI systems.

AI tools may generate inaccurate, incomplete, or nonexistent citations. Authors are responsible for ensuring that every reference is genuine, relevant, correctly cited, and accurately represents the source.

AI systems should not be treated as primary sources for scientific claims. ICMJE specifically emphasizes that humans remain responsible for appropriate attribution and for ensuring that plagiarism has not occurred in AI-assisted content.

6. AI-Generated Images, Figures, and Data

Authors must clearly disclose the use of AI in generating or substantially modifying images, figures, tables, datasets, analyses, or other research materials where applicable.

AI-generated or AI-modified material must not be used to fabricate, falsify, manipulate, or misrepresent scientific findings.

Where an AI tool has been used in data analysis, figure generation, image processing, or other substantive research activities, authors should describe the tool and its use in the appropriate Methods or other relevant section of the manuscript.

7. Fabrication and Misrepresentation

The use of generative AI must never be used to fabricate:

• Research data
• Experimental results
• Patient information
• Clinical observations
• Statistical findings
• References
• Images or figures
• Ethical approval documentation
• Reviewer reports
• Other scientific or editorial information

AI-assisted fabrication, falsification, plagiarism, or deliberate misrepresentation may be treated as research or publication misconduct.

8. Confidentiality and Patient Information

Authors must not enter confidential patient information, identifiable medical information, unpublished research data, or other sensitive material into public or third-party AI systems unless appropriate safeguards, authorization, and confidentiality protections are in place.

Particular care must be taken with information obtained through a doctor-patient relationship.

9. AI Use by Peer Reviewers

Manuscripts submitted to the journal are confidential and constitute privileged communications.

Reviewers must not upload submitted manuscripts, reviewer comments, unpublished data, or other confidential material into AI systems where confidentiality cannot be assured.

Reviewers must follow the journal's stated requirements and obtain permission from the editorial office before using AI technology to assist with a peer review where required.

If AI is used during peer review with permission, the reviewer remains fully responsible for the accuracy and appropriateness of the review and should disclose the use of AI to the journal.

10. AI Use by Editors and Editorial Staff

Editors and editorial staff must protect the confidentiality of submitted manuscripts and peer-review materials.

Editors and reviewers should not upload confidential manuscripts into AI systems where confidentiality cannot be assured unless the authors have explicitly permitted such use.

Editors remain responsible for editorial decisions and must not delegate independent editorial judgment to AI systems.

11. AI in Editorial and Production Processes

The journal may use AI-assisted technologies for limited administrative, language, formatting, accessibility, or production purposes where appropriate.

Where AI is used by the journal for copyediting, production, or other editorial services, the journal will maintain appropriate human oversight and quality control.

AI-generated or AI-assisted material must be reviewed for accuracy, validity, confidentiality, and compliance with journal policies. ICMJE recommends that journals disclose relevant use of AI in editorial and production processes.

12. AI and Authorship

Generative AI tools, chatbots, LLMs, and other AI systems cannot be listed as authors or co-authors.

Authors must retain full responsibility for the manuscript and must meet the journal's authorship requirements independently of any AI assistance.

13. Copyright and Intellectual Property

Authors are responsible for ensuring that AI-assisted content does not infringe copyright, intellectual property, privacy, or other rights.

Where AI-generated or AI-assisted content incorporates material derived from existing sources, authors must ensure appropriate attribution, permissions, and citation where required.

14. Non-Disclosure of AI Use

Failure to disclose substantive AI use when disclosure is required may constitute a breach of the journal's publication policies.

Depending on the circumstances, the journal may request clarification, require a correction, suspend editorial processing, reject the manuscript, or take appropriate post-publication action.

ICMJE notes that nondisclosure of AI use may require corrective action and may, in some circumstances, be considered misconduct.

15. Editorial Right to Request Clarification

The editorial team may ask authors, reviewers, or editors to provide additional information regarding the use of AI technologies.

Where necessary, the journal may request details regarding the AI tool used, its purpose, the content affected, and the human verification or review undertaken.

16. Commitment to Responsible AI Use

The Netherlands Journal of Critical Care supports responsible and transparent use of generative AI while recognizing that AI technologies cannot replace human scientific judgment, authorship, accountability, or ethical responsibility.

The journal's policy may be updated as AI technologies, medical publishing practices, research-ethics standards, and international recommendations evolve.

The journal follows the current ICMJE Recommendations on AI in publishing and will consider relevant developments in responsible AI guidance when reviewing and updating this policy.