The description of touch-casting (p.75) is (in my opinion) kind of confusing. I've seen a lot of players not realize that touch-casting a healing spell on an unconscious player doesn't get through their Spell Shield. Also, in the current wording, it says "the target must be conscious to accept an effect" which could be read to imply that you can't touch-cast at all on an unconscious target (regardless of protectives) since the target has to accept a touch-cast. I think the issue is that there's two different notions of "accept" in this section ("accepting" being affected by the touch-cast at all, and "accept" as in allowing it through your protectives) which isn't totally clear.
My proposed reword would be as follows (replacing everything under the "Touch Casting" heading on p.75):
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To touch cast, hold at least one packet in your hand and place it against the target you wish to affect. Touch casting avoids the chance of missing your target. You may not touch cast (even on yourself) if both of your arms are bound in any way. Touch casting can only be used for effects delivered with the Spell, Elemental, or Arcane qualifier.
If the target is conscious, they may choose to accept or refuse the effect; this decision must be made immediately after the effect is cast. If they accept, it will pass through the target’s protectives such as Spell Shield or Reflect Spell. (They can only allow touch-cast spells through their protectives, not thrown spells.) If they refuse, they must say “refused”. This will expend the effect, but have no effect whatsoever on the target (regardless of whether or not the target has any protectives). Refused spells can be meditated back.
If the target is unconscious, they may not refuse the effect, but they also are not able to allow the spell through their protectives. For instance, if a PC casts a healing spell on an unconscious target with an active Spell Shield (whether through touch-casting or thrown), the target must call their Spell Shield and block the spell.
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