Originally funded and experienced by millionaires and billionaires willing to spend hundreds of thousands or even millions for an extreme adventure where previously only explorers and scientists previously dared to go, extreme environment (i.e. polar, tundra, desert, space, space analog, deep ocean, mountaineering, nuclear meltdown sites etc.) tourism is becoming more common allowing more people to be exposed to increased dangers and risks that such tourists will be exposed to. Some of those risks might be relatively minor such as possibly minor motion sickness. Other risks, however, could include serious injury, such as in the case of the Titan submarine which imploded on a tour to the Titanic in June 2023, death. The disaster, caused primarily by cost cutting measures and disregard of the danger from the company running the tour, which caused all 5 people on board to be killed instantaneously. This presentation and paper will expand on previously published work on the medical and ethical dilemmas of space tourism as well as include an additional focus on tourism to other extreme environments including the neonate industry of space analog tourism where individuals pay to participate in a space analog mission at a hefty fee while potentially contributing or disrupting the legitimate scientific research going on such missions while still exposing themselves to additional risk which they might be unsuited for. Further, this will discuss a few of the lesser known risks and concerns that have come more recently to light as well as a discussion as to not only if adults should be able to ethically, morally, and legally consent for their children during these high risk activities but whether or not, given the human brain does not fully develop until a person is in their mid-20s, how old should a person be in order to adequately understand and appropriately balance the risks and requirements of an extremely dangerous environment and be able to fully consent to the tourism venture’s risks.