Eldritch Horror
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What does "Lose X unless you ..." mean when I decline or cannot pay?
Several experienced players agree; no official ruling.
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The "unless" part is a choice. If you decline or cannot pay, the loss happens, even if it defeats you. If you could prevent the alternative, you are safe from it, and a loss you chose to take can still be prevented, whereas Health or Sanity spent as a cost cannot.