Dying for Death Saves

I hate exhaustion in D&D 5e. It's a total hack. Let's fix it!

On the other hand, I love the death save mechanic. It's a lot of fun. Let's smash them together and see what happens.

I also ran a poll on X that showed a very interesting divide between how much healing a long rest should grant. 52% wanted all their hit points back. That's a lot, but 48% didn't.

That's the kind of divide that screams for optional rules. So, here is my idea - death saves now carry over. If you are dying and pop back up, you keep your failed death saves. With enough fails, your maximum hit points drop.

I think that might be a workable compromise between characters that bounce back easily, and a game that gives some teeth to near death experiences.

With that change, I can then also run exhaustion through the death saves mechanics. Getting a level of exhaustion gives you a failed death save.

The rules are below, but there are a few big questions to ask:

• What penalties should come with failed death saves?

• How many failed death saves are enough?

• I also stripped out the three saves and you are stabilized rule, simply because I like the threat of death requiring active intervention by other PCs. Good idea or bad idea?

Rules below, draft so don't be shocked by typos:

Damage and Healing

When an attack hits your or your suffer the effects of a deadly spell such as lightning bolt, you take damage and might perish.

Hit Points

Hit points are an abstract measure of physical durability, luck, energy, and mental fortitude.

Maximum Hit Points

Your maximum hit points represent your sturdiness when you are fully rested and healthy. You can’t have more hit points than your maximum.

Current Hit Points and Damage

When you take damage, you subtract that amount from your current hit points.

Healing

If a healing effect restores your hit points, you increase your current hit points by the amount healed.

Bloodied Hit Points

Your bloodied hit points equal half your maximum hit points. You are considered bloodied while your current hit points are less than or equal to your bloodied hit points.

Minimum Hit Points

Your hit points can never be reduced to less than 0. Ignore any extra damage that would reduce you below 0.

Dying and Death Saves

When your hit points reach 0, you are unconscious and dying.

Unconscious

When you become unconscious, all durations of effects, spells, and features you control immediately end. You no longer count as an enemy or ally for any effects. You can't use actions or reactions.

Dying

When your hit points reach 0 and you start dying, and at the start of each of your turns while you are dying, you must make a death save. You must also make a death save each time you take further damage while dying.

To make a death save, roll a d20. If you roll less than 10, you suffer a failed death save. Otherwise, you forestall death for a moment.

A death save is a special saving throw. Saving throw modifiers do not apply to it unless they specifically apply to death saves.

Failed Death Saves

1 Failed Save: No effect

2 Failed Saves: No effect

3 Failed Saves: Treat your bloodied hit points as your maximum hit points

4 Failed Saves: Death

Recovery

As soon as you receive 1 or more points of healing, you are no longer dying and unconscious. However, you still suffer the effects of your failed death saves if any. If you take enough damage to become dying again, you still count your prior, failed death saves.

Stabilize

You can use an action to make a DC 10 Intelligence (Medicine) check to stabilize a dying creature. A stabilized creature automatically succeeds death saves until it takes any more damage. It then starts dying once more. If it receives any healing, it recovers as described above.

Removing Failed Death Saves

While you are at your maximum hit points, you remove one failed death save and its effects after a long rest. Note that in the case of having 2 failed death saves, you maximum hit points are then restored to normal, requiring more healing to reach your maximum and then remove more failed death save.

Starvation/Drowning/Extreme Temperatures

Most effects that grant exhaustion now grant failed death saves. There are likely exceptions that I need to work around, but the intent is to replace exhaustion levels with failed death saves.