The integration of genetic information (GI) into the electronic health record (EHR) seems inevitable as the mainstreaming of genomics continues. Such newly provided accessibility to GI could be beneficial for improving health care, as well as for supporting clinical decision‐making and health management. Notwithstanding these promising benefits, the automatic integration of GI into the EHR, allowing unrestricted access to one's GI through patient portals, carries various knowledge‐related risks for patients. This article is focused on the potential case of inadvertently revealing (...) misattributed parentage through such practice. The article aims to identify key clinical and ethical implications of such revelation for adult patients. Clinical implications include, for example, altering the physician‐patient interaction and the need to enhance physician's genetic literacy to improve genetic‐information‐specific communication skills. Ethical implications yield arguments supporting disclosure of MP, such as autonomy, individuals' right to know medical information pertaining to them, and the right to know one's genetic origins. Arguments opposing disclosure of MP centre on the right not to know GI and concerns for post‐disclosure family relationships. Following the clinical and ethical analyses of these respective implications, we consider how such integration of GI into the EHR ought to be carried out, ethically. We therefore suggest a solution, featuring an autonomy‐based approach, built around EHR users' right not to know. Our solution of nuanced consent options (including a ‘genetic ignorance option’) is designed to enable patients' informed exposure to GI through the EHR, allowing them some control over their self‐ and familial narrative. (shrink)

In the vast literature centering on the Itinerarium Egeriae there is a serious lacuna. No attempt has been made to analyse the circle of readers to whom this remarkable document was addressed and for whose sake Egeria recorded so faithfully every detail of her journey. Yet if a full understanding of the IE is to be achieved, some definition of the circle of Egeria and of its relations with the pilgrim is essential. In other words, who in the West at (...) that point in the late fourth century, would have been so interested in Holy Land pilgrimage as to read attentively such a personal account as the IE? The following is a tentative essay to gauge the concerns, expectations and cultural background of Egeria's immediate circle of readers through her own emphasis on various aspects of her pilgrimage. In addition, the investigation will try to assess the place of pilgrimage in the life of western communities and the value of communications between the pilgrim on the road and the society back at home. (shrink)