Because of production issues, there has to be an even number of cardboard components of each shape. You don’t need this tile in the game.
However, you can use this extra tile if one of your Event Tiles gets damaged on the reverse side.
If you have no monsters, you have no choice and gain 3 Evil.
If you are on (or close to) the top of the Evilometer, you can still choose to not discard a monster and thus gain 3 Evil, even if your Evil Counter will actually move less than 3 spaces or not at all.
No, you do not pay the cost of a monster eaten by a Demon, nor do you gain 1 Evil for not paying it.