The Mechanics of Zero Hit Points

In D&D 5th Edition, the rules for falling to 0 HP are covered on page 197 of the PHB. Essentially they say a character who drops to less than 1 hit point falls unconscious, a special condition that prohibits that player from making any actions except, on their turn, making a unique Death Saving Throw. If the player makes three successful Death Saves, they stabilize (remain at 0 HP but are no longer required to make the Death Saving Throws). If they fail three Death Saves before they stabilize, the character dies.

Why This Needs a House Rule

The primary issue with the Death Saving Throw system is that it forces players who fall unconscious to essentially stop playing the game and instead focus on a peculiar little dice-rolling minigame. Their fate is more or less exclusively in the hands of their fellow party members at that point. This can add some tension to these moments, but it feels like it favors a grim-and-grittier style of game than we tend to want to run. What we’re looking for is a bit more agency for players who are close to death, which opens the door for more cinematic drama and victory-from-the-jaws-of-defeat style moments.

The House Rule in Detail

When a character falls below 1 HP, at the DMs discretion, they do not fall unconscious but rather gain a new condition called “Fighting For Life.” Characters who are Fighting For Life have the following characteristics:

1. Their movement is reduced to 5 feet, maximum, and are unable to burrow, climb, fly, hover, swim, or planeshift. They can be prone, kneeling, slumped against a wall or terrain feature, or be leaning heavily on a piece of equipment like a weapon or staff, as described by the player/DM.
2. They may speak only haltingly, breathlessly, or with great strain and effort.
3. Any spell, feature, feat, or ability that is affected by rules that indicate consciousness (e.g. a spellcaster’s concentration or a Barbarian’s Rage) is treated as if the character were unconscious. This also means characters Fighting For Life may cast spells that have a concentration effect, but cannot hold concentration on them (the effects end immediately upon casting).

At the end of a character’s turn, if they are Fighting For Life, they must make a Death Saving Throw as described in the PHB page 197. However, instead of a flat DC 10, the base DC is 10 and is modified by how close the character is to final death and how much effort they spent continuing to contribute to the combat or their party’s goals, as opposed to focusing on staying alive.

A character who is Fighting For Life may perform most of their normal turn actions, but each action they take modifies the base Death Saving Throw DC (see Action Type DC Modifiers Table , below). The amount of impact these actions have on the final Death Save DC depends on how close to death’s door that character is and what they’re trying to do.

To calculate the DC modifier for the death save, find the column on the DC Modifiers table that corresponds to the number of failed death saves so far. For each action type taken during the turn, add the corresponding modifier(s) to the base Death Saving Throw DC. Note that successful death saves have no affect on the final DC.

Before a player’s turn ends and they make their Death Saving Throw, the character must declare whether or not they are reserving their Reaction. When Fighting For Life, a character must focus their energy and mental fortitude on responding to their environment, which distracts them from trying to will their body into survival. Unfortunately, this pull of focus occurs whether the opportunity to respond presents itself or not. A player who takes the DC penalty and reserves their Reaction may take any of their usual reactions during the rest of the turn, but there is no effect if a reserved Reaction never gets used.

Once the final Death Saving Throw DC is tallied, the player makes the saving throw, noting whether they succeed or fail on their character sheet as normal. Note that most characters cannot use skills, Proficiency Bonuses, or Advantage to modify their Death Saving Throw roll so it is possible to stretch the DC beyond the capacity of success through a player’s choices, particularly when trying to self-heal.

Note that players may spend Inspiration to automatically succeed on one Death Saving Throw, but players cannot gain inspiration while Fighting For Life.

self-Healing

If any action taken by the character who is Fighting For Life would result in that character gaining hit points or stabilizing their condition, (e.g. casting Spare the Dying, drinking a Potion of Healing, using a Healer’s Kit, etc) they must use the Self-Heal Base DC and then immediately make a Death Saving Throw with that DC plus the modifiers from any Actions taken thus far (including the one used to stabilize). If they fail the saving throw, the attempt to self-heal fails: their weakened state made their spell fizzle; they fumbled the potion bottle due to fingers slick with blood; the medical kit was missing the item needed to counteract the effect. Whatever the description, the character cannot stabilize, they cannot take a Reaction this turn (unless they already Reserved it, and added it to the DC), and their turn ends.

Clarifications and Definitions

Action Type DC Modifiers

Self-Healing as a Reaction

There are no spells (currently) that provide self-healing and have a casting time of Reaction. However, if any Reaction taken by the character Fighting For Life would stabilize that character, before carrying out that Reaction, they must first make a death save against a DC of 21. If the save succeeds, that character does not mark a successful death save, but rather they may continue executing their Reaction as normal (including stabilizing the character if that part of the Reaction resolves).

If the character has two failed saves before this saving throw and this throw fails, the character dies (see Dying, below). If the character has one or zero failed saves before making this saving throw and this throw fails, they mark a failed death save and may continue executing their Reaction. However, any hit point gain or stabilization effect that would stabilize the character Fighting For Life instead has no effect. Any other effects from the Reaction can resolve as normal.

DM Notes: This provision is included primarily to prevent the use of the Ready action for a self-healing ability or spell as a means to avoid the DC modifiers to the Death Saving Throw. Because the Ready action uses the character’s Reaction to execute the Readied action and any reserved Reactions occur after the Death Saving Throw for the turn, it would otherwise be possible for a Fighting For Life character with one failed death save to Ready a quaff potion action (for example) setting the trigger condition as “the start of the next creature’s turn.” They would then make a Death Saving Throw against DC 13 (Reserve Reaction adds a +3 modifier to the death save on one failure) and when the next creature’s turn starts, that triggers the Reaction causing them to drink the potion and stabilize, avoiding what otherwise would have been a mid-turn Death Saving Throw against a DC of 20 and improving their odds of success by a whopping 35%.

Examples

• Krayna and her party are fighting a monster who succeeds with a ranged attack that drops Krayna to 0 hit points. On her next turn she decides she wants to try to get revenge on the creature who wounded her by casting Lightning Bolt at it—her Action (+5 DC Modifier)—plus she wants to reserve the option to cast her Shield spell if she’s attacked while Fighting For Life—Reserve Reaction (+4). This makes the DC of her Death Saving Throw at the end of her turn 19. The Lightning Bolt succeeds in downing the monster who injured her, which ends combat. Even though she won’t use her Reaction, her choice to select it still affects the DC for her Death Saving Throw. She rolls against a DC 19 and gets a 19, giving her team a bit of breathing room to get her patched up.
• Poppin is fighting alone against a goblin who gets a lucky shot in and drops Poppin to a knee. Poppin’s first turn after starting to Fight For Life, he chooses to Move (+1 to DC) to an adjacent square on the map where there is a countertop, and then he tries to Hide (Action, +5 DC) beneath the counter so he can attend to his wounds. His total DC is now 16. He rolls his Death Saving Throw at the end of his turn but fails the Death Save with a roll of 8. The goblin spends its turn searching for Poppin but failing to find him. On Poppin’s next turn, he declares he wants to try to chug a healing potion. Since he’s trying to Self-Heal, he immediately makes his Death Saving Throw using a base DC of 16 and adding the +4 modifier for the quaff potion Action. With the final DC set at 20,  Poppin rolls a 9. The DM determines that Poppin reached into his bag and found that someone had stolen all his potions! Poppin suffers a second failed Death Saving Throw and is in big trouble!

Dying

As soon as a character fails their third Death Saving Throw, that character dies or falls Comatose, at the DMs discretion. If the DM declares the character dead, they are permitted to speak their last words before succumbing to their wounds. At this point only divine or magical intervention can save them.

Taking Damage While Fighting For Life

If a character takes damage while Fighting For Life, they suffer an immediate failed Death Saving Throw. If the final damage total is equal to or greater than the character’s Max HP, that character dies instantly. If not, the character suffers one failed Death Save and is still Fighting For Life.

Modifiers and Advantage

Under the Rules as Written, death saves are typically not modified by any effect. They are a time-delay device to give a sense of tension so they amount to a series of coin flips (in all honesty, they could just be handled by flipping a coin and the effect would be identical). Because these house rules modify that element, it would be reasonable to wonder whether dice modification effects would still be in play.

Generally speaking, because the Fighting For Life condition is treated mechanically almost identically to the unconscious condition (concentration loss, spell effects failing, etc) a lot of the easy interactions are handled by that rule. If you were under the effects of a Bless spell and you fell to zero HP and started Fighting For Life, those effects would fall off immediately. But because a character Fighting For Life is not effectively removed from the turn order the way an unconscious character would be, you might be tempted to cast Bless on a character Fighting For Life, possibly including yourself.

The core of this clarification is that spells which would modify the death save do work as expected, provided they provide only a flat bonus or a randomized modifier to saving throws. Death saves are not attack rolls, damage rolls, or ability checks so features or spells which modify those rolls but do not specify saving throws have no effect (for example, Guidance only modifies ability checks so has no impact on death saves; but Bardic Inspiration does apply to saving throws so it would benefit a character Fighting For Life).

If a spell or feature provides advantage on saving throws, however, that effect is replaced by adding a flat bonus to the death saving throw equal to the Constitution modifier of the character who is Fighting For Life. This represents a character digging deep into their body’s will to survive and drawing on everything they can to get back in the fight. Note that if a character has a negative Constitution modifier, this effect is ignored as a replacement for advantage. If a spell or feature would force a character who is Fighting For Life to make their death saving throw at disadvantage, that effect is ignored unless the character has a negative constitution modifier, in which case the modifier is added to the roll.

DM Notes: The reason for eliminating advantage and disadvantage from death saves is largely to avoid cases where dis/advantage cancels out the math used to tune the DC modifiers. Flat or randomized bonuses are easier to evaluate for efficacy, particularly when the spell or feature effect is applied by the character who is Fighting For Life themselves.

Natural Ones and Twenties

Under the Fighting For Life house rules, natural ones and twenties do not have special effect (i.e. they do not count as multiple failed/successful saving throws). These rules in the PHB and DMB seem designed to add narrative tension to the death save mechanics which are already handled by the variable DC in these house rules so in most cases a roll of a 1 is simply a failed death saving throw and a roll of 20 just gives a player the highest chance of surpassing the DC.

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