This book about health care ethics argues that our reasoning should include "second thoughts" about our emotions and initial reaction to an issue. "Second Thoughts" considers AMA and ANA ethical reasoning, US Supreme Court decisions, aid-in-dying laws, feminist ethics, East Asian and Islamic traditions, as well as Catholic teaching. Each chapter includes case studies and questions. A chapter examines decisions by the Trump administration that impact health care policies and funding for the Affordable Care Act. Ethical reasoning reflects the values of our community. This is largely what makes our reasoning convincing. Reasoning may also "trigger new intuitions," and together with our reasoning these "second thoughts" may alter our community's moral narrative. Our ethical challenge is to consider carefully how we express both our emotions and our reasoning. This will require being open to new ideas and to having second thoughts about some of our moral judgments. We begin this quest by distinguishing three patterns of reasoning. First, we often address ethical choices by identifying a person's duty or rights. At all levels of life our society makes rules to enforce this reasoning. Asserting that a person's human dignity entails a right to consent to medical treatment is an example in health care. As is arguing that the patient's right implies the physician has a duty to obtain the patient's informed consent. Second, we use reason to identify and set goals about how we should act as persons and communities. In health care, we affirm that caregivers should not only provide care, but also be caring persons. To be caring is not a specific action, but a way of being ethical when we take every action. We use this kind of reasoning to affirm that expressing empathy is intrinsically good-good in itself, apart from any measurement of its consequences. Third, we also reason that an ethical decision should be evaluated by its results. As we are unable to know all the results of a decision before we make it, this kind of reasoning involves making predictions of the likely outcomes in taking an action. Caregivers use this reasoning to predict what is in the best interests of a patient and to weigh the likely benefits of treatment against the probable risks. And we, in our everyday lives, rely on consequential reasoning to weigh possible benefits and risks. Reasoning in terms of goals and results are both forward looking, but each has a different way of evaluating what is better or best. We set goals to clarify our intended state of mind as we act. Having a caring state of mind is relevant for every health care decision. When we predict results to justify the action we are about to take, we often ignore our state of mind. Being ethical involves being mindful of your embodied emotions-the intuitive language of your soul. Acting with a caring state of mind is good in itself and always a choice you can make. Your state of mind will always affect your life and probably the lives of others as well. In making decisions by predicting likely outcomes, you should have "second thoughts" about what you think you know and also about what may simply be unknowable. Robert Traer teaches for the Dominican University of California. He has a JD in law and a PhD in world religious. His books include: Doing environmental Ethics (second edition), Doing Ethics in a Diverse World (with Harlan Stelmach), and Faith in Human Rights: Support in Religious Traditions of a Global Struggle. He and his wife, Nancy, have been married fifty years and have five children, including two adopted from East Asia. They are blessed with ten grandchildren.
