Each year roughly 1,000 climbers set out to scale Mount Everest, and each year some of them meet tragic ends on the mountain’s heights. This year, the mountain’s grueling conditions have already claimed five lives, including that of Australian Maria Strydom, who had headed there to demonstrate that vegans are no less athletically capable than others. Some 30 others have suffered altitude sickness, sparking several rescue efforts over the weekend.

Every adventurer sets out with the hope that all will go according to plan and that they will return from their endeavors to adulation and praise. Unfortunately, daring ventures don’t always go so smoothly, as in Strydom’s case, and we spectators at home are left footing the bill.

When things go wrong, should we pull all the stops to rescue extreme athletes and thrill seekers? Should you and I pay for their shenanigans?

Taking an occasional risk is good fun. Few things make one feel more alive than running a marathon for the first time, or trying a double black diamond on the ski slope. With signage, qualification standards and training encouraged, these kinds of risks normally are exciting but safe. Less than one person per 100,000 die while running marathons, and only about 41 people out of 50 million die on the slopes.

Then there are those who choose to row an unpowered boat unaided across the Atlantic ocean or skydive into a Siberian lake ice hole. For these people, ordinary risks are not enough, and in seeking their thrills they go outside normal parameters, undertaking extraordinary tasks in exotic, often remote locations. The freedom afforded by taking on this kind of risk is, however, two-sided: While the uncharted terrain of hyper-risk means no one is there to stop you from trying, it also means no one is there to bail you out if things go wrong.

For better or worse, the United States tries to let people take risks as long as they do not interfere with others. Want to smoke? Do it outside away from buildings. Want to ride a motorcycle? Get a license - adults can even skip the helmet in 28 states. We don’t like imposing our understanding of the good life on one another, so if fewer total years (or fewer with functional body parts) on a bike is your ideal, ride on! But calculating the cost of risk-taking to others is not that simple.

The problem with this tolerance is threefold. First, your lung cancer from smoking and brain injury from a bike wreck tax the health-care system: Close to $170 billion is spent on smoking-related medical services each year, and more than $156 billion is lost in productivity due to premature death and exposure to secondhand smoke. Injuries and deaths from motorcycle crashes cost approximately $12 billion in one recent year, and one study of 105 hospitalized motorcyclists showed that 63 percent of their care was paid for with public funds. Second, few people are capable of accurately weighing the benefits against such unfamiliar risks as inability to breathe unassisted or suffering locked-in syndrome because of a brain injury, so it’s difficult to say thrill seekers are taking fully “informed” risks. Third, we feel obligated to help our fellow citizens, and are usually willing to rescue the barely sane — whether naive first-timers or skilled experts bored with available risks — when their feats go awry.

As much as we encourage athletes to engage at their own risk, the downside when it happens is shared.

Reza Baluchi, an endurance biker and runner, attempted “running” more than 1,000 miles in a giant inflatable bubble from Florida to Puerto Rico in 2014 and had to be rescued. As he prepared to try again this year, the Coast Guard warned him not to depart with threats of a $40,000 fine and up to seven years in prison. Baluchi tried anyway. The Coast Guard rescued him — again. And spent $140,000 doing it. That is my money and your money bringing him back, and enabling his next attempt.

Harrison Fast, an American expert skier who went speed flying (a combination of skiing and paragliding) in the Swiss Alps with friends recently, was not so fortunate. After he began his run, he vanished on the mountain. Authorities searched for three days, then gave up. His family and his employer, however, dropped their lives and wallets to coordinate more search teams including both humans and drones.

The risks Fast took were, in other words, never his alone. The Swiss Police flew several helicopters over their several-days search, for which they sent Fast’s parents a substantial bill, according to a family member. If they hadn’t been able to pay, Fast’s rescue efforts, unlike Baluchi’s, would have placed burdens on taxpayers of another country altogether. As it happened, Fast’s family raised over $70,000 via crowdfunding to pay the bills and charter their own rescue helicopter. But when it comes to private fundraising, only those with social media savvy and associates of some means are capable of collecting anything close to that sum. Is this fair to those with less resources involved in adventure accidents, or to those who need saving for other reasons, like natural disaster or poverty?

Baluchi and Fast were both skilled experts pushing the envelope. Those with proper training who demonstrate the edge of human endurance, strength, and ingenuity deserve some respect.

But there are countless less experienced adventurers making bad choices. The National Park Service, one of several entities responsible for search and rescue, spends about $5 million a year pulling amateur hikers off the steepest mountains because they are too tired to climb down and piloting helicopters over avalanches triggered by skiers who went off the path. These are not victims of understandable mistakes or fluke accidents on sanctioned trails — these are people taking serious risks for which they are unprepared.

Some might be tempted to dismiss the issue, saying not enough people take these risks to cost the rest of us all that much, so just save these risk takers and be done with it. But extreme sports are incurring a massive rise in popularity, likely fueled in part by boredom with mainstream risks and likely in part due to glorification of extreme sports through Go-Pro recorders and social media. And, with the easy availability of new and improved tools, such as GPS, drones, and improved helicopter technology for saving thrill seekers, we have unprecedented capacity to rescue. The Niagara Falls barrel daredevils of yesteryear did not expect to be rescued.

Just as the Coast Guard rolled its eyes and went for Baluchi, we agree that thrill seekers in perilous situations should be saved. But we support the obligation to rescue with one important stipulation: Let’s hold the risk takers responsible.

To protect everyone from the costs of risk-sharing, let’s ensure extreme athletes prepare more than just their GPSs and inflatable vests. Let’s make sure they add up the cost of saving their butts, and have them explain how they’ll cover it before taking off. In many parts of Europe you need loads of money or rescue insurance to pay for adventure bailout, so why can’t we get legislation passed in the United States to safeguard the Coast Guard for choosing not to rescue without this documentation? Wealthy benefactor promissory notes are perfectly acceptable. Or, if a satisfactory deposit cannot be made, have the risk taker commit to community service proportionate to the rescue costs if things go south.

In addition, the risk takers should be expected to plan for trouble. They can even explicitly relieve their communities of the burden of saving them. If Fast could foresee the grief of his mother, friends and co-workers, he probably wouldn’t have given up speed flying, but he might have made his mother promise not to search for him too long. He might explain that the possibility of injury or dying is part of what makes his life worth living. Just as we can all sign “Do Not Resuscitate” orders to prevent living unacceptable qualities of life after a cardiac arrest, perhaps it is time to insist that extreme athletes who can’t or won’t put down a deposit or commit to community service sign “Do Not Rescue” instructions. Either account for the costs or tell us not to come looking for you — but don’t assume that the choppers will be on their way free of charge because a storm picked up the day you decided to try to row across the Atlantic in a bathtub with a spoon.


- Arthur L. Caplan is the director of the Division of Medical Ethics at NYU Langone Medical Center’s Department of Population Health. Brendan Parent is Co-Director of Sports and Society and Director of Applied Health at NYU School of Professional Studies.