We discuss the implications of approximate particle-hole symmetry in a half-filled Landau level in which a paired quantum Hall state forms. We note that the Pfaffian state is not particle-hole symmetric. Therefore, in the limit of vanishing Landau level mixing, in which particle-hole transformation is an exact symmetry, the Pfaffian spontaneously breaks this symmetry. There is a particle-hole conjugate state, which we call the anti-Pfaffian, which is degenerate with the Pfaffian in this limit. We observe that strong Landau level mixing should favor the Pfaffian, but it is an open problem which state is favored for the moderate Landau level mixing which is present in experiments. We discuss the bulk and edge physics of the anti-Pfaffian. We analyze a simplified model in which transitions between analogs of the two states can be studied in detail. Finally, we discuss experimental implications.
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