Death and Dying

( ⇪ Adventuring Variants )

Under the standard d20 rules, unconsciousness and death are predictable states: When a character reaches negative hit points, he goes unconscious. When he reaches -10, he dies.

This variant takes away some of that predictability. No longer does a dying character have a set number of rounds to live. This heightens the tension in combat when one of your allies has fallen, because you don’t know exactly when the clock is going to run out.

With this variant, characters can’t be reduced to negative hit points — 0 is the minimum. There is no automatic hit point total at which a character dies. Instead, any character who takes damage that reduces his hit points to 0 must make a Fortitude save (called an “Injury Save”) to avoid falling unconscious or dying. Fear effects and stress effects (such as shaken T) don’t affect you while you’re unconscious, but do apply if you’re conscious at the time you make an Injury Save. However, while you’re at 0 hit points your reserve points do not function in any way. The amount of lethal damage that brought you to 0 and ever since then is tracked on your character sheet as your “wounds”. Wounds make it much harder to stay alive, and persist until you have them removed by resting or getting treated by a doctor.

You can determine whether a creature is disabled, dying, inert, stable, destroyed, or dead, and roughly how many wounds the creature has (rounded down to the nearest 5) by moving adjacent to the creature and making a DC 10 Heal check as a standard action. If the creature is a living construct or quesar, it requires 1 rank in the Craft (armorsmithing, blacksmithing, gemcutting, or sculpting) skill and a DC 15 Heal check instead. If it’s an undead or deathless or non-living construct, you can’t tell for certain unless you created it (in which case you’d know on-sight without a check). For other creature types, the GM may raise the DC and/or require a rank in a relevant knowledge skill depending on how different the creature’s anatomy is from you.

The Injury Save


When a creature’s hit points are reduced to 0 by lethal damage, note how much lethal damage brought it to 0. This is added to their current amount of wounds. The creature must attempt an Injury Save (DC 10, +1 per 5 wounds), keeping in mind if they’re conscious at the time then stress effects do apply to this roll (they very likely are shaken T and thus take a -2 penalty to the saving throw). Success means the character is disabled; failure indicates that he is dying. Failure by 10 or more means the character is dead. If the character rolls a natural 3, he is dying. Calculate the numeric result; if he missed the DC by 10 or more, he is dead. NPCs and enemies make the save with a roll instead of using their fortitude score. A quesar or living construct that would gain the dying condition instead becomes inert (as does a quesar that would die outright).

GM’s Note: Mentions of the term “FP” in the flow charts refer to Fortitude Points, a new “gradual defense” all creatures have.



A disabled character is conscious, but can only take a single move or standard action each turn (but not both, nor can she take full-round actions). She moves at half speed. Taking move actions doesn’t risk further injury, but if a disabled character (except for a quesar or living construct) takes any standard action (or any other action the GM deems strenuous, including some free, swift, or immediate actions such as casting a quickened spell) that leaves her at 0 hit points, she must succeed on an Injury Save (against the same DC as made previously, keeping in mind if they’re conscious at the time then stress effects do apply to this roll) to remain disabled; otherwise, she becomes dying after she completes the action.

If a disabled character takes any new lethal damage, that is added to their wounds as well, and she must make a new Injury Save (DC 10, +1 per 5 wounds), but any result other than dead means the character is now dying. A disabled character who is dealt (or who is currently suffering from) any nonlethal damage is unconscious and helpless but does not begin dying. A creature with the living construct subtype that becomes disabled is unaffected by strenuous activity, but does still have to make an Injury Save if he takes new lethal damage.



A dying character is unconscious and helpless and near death. While in the dying status, you roll “Special Injury Saves” where — at the start of each of your turns except for your first turn after entering the “dying” status — the DC increases by one (so a Special Injury Save is DC 10, +1 per 5 wounds, +1 per round of being in the “dying” status after the first). If a “dying” character takes additional lethal damage, it’s added to their wounds and they make an immediate Special Injury Save. If the character fails the save, they die. If the character succeeds then they remain in the “dying” status.

At the start of each of that dying character’s turns they must make another Special Injury Save (with increased difficulty) to try to become stable. Again, if the character fails the save, they die. If the character succeeds on this save by less than 5, they do not die but do not improve. If the character succeeds on this save by 5 or more but by less than 10, they become stable but remain unconscious. If the character succeeds on this save by 10 or more, they become conscious and disabled. Another character can make a dying character stable by succeeding on a DC 15 Heal check as a standard action (which provokes attacks of opportunity).

GM’s Note: When in the dying status a PC at the start of their turn can use an action point to automatically stabilize instead of rolling an Injury save (and this counts as getting outside help). If they choose to roll it though, they have to accept the roll.

A quesar or living construct that would gain the dying condition instead becomes inert. A creature that would otherwise be destroyed at 0 HP is destroyed.


Only quesars or living constructs can become inert. An inert creature is unconscious and helpless and can take no actions. A quesar returns to 1 HP after 1 minute of being in daylight (as described in its fast healing ability) without taking any more lethal damage (more lethal damage has no other effects on a quesar). If an inert living construct takes lethal damage, that damage is added to their wounds and it must make a new Injury Save (DC 10, +1 per 5 wounds). If the living construct fails the save, it dies. Otherwise, it remains inert.



A stable character is unconscious and helpless. If a stable character takes any new lethal damage, that damage is added to her wounds and she must make a new Injury Save (DC 10, +1 per 5 wounds) to remain stable. If the character fails the save, she becomes dying, otherwise she remains stable.

Every hour, a stable character must succeed on an Injury Save (DC 10, +1 per 5 wounds) to remain stable. If the character fails the hourly save, he becomes dying instead. If the character succeeds on the hourly save by less than 5, he does not get any worse, but does not improve. However, if the character stabilized himself with no help, the DC for this now-special Injury Save increases by +1 per hour beyond the first (anything else can still stabilize you properly). Either way, he is still stable and unconscious, and must continue to make Injury Saves every hour. If the character succeeds on the hourly save by 5 or more, he becomes conscious and has 1 hit point (any nonlethal damage or strife still applies). Any number of characters can each grant a stable character a +2 bonus on his hourly Injury Save to remain stable by tending to him for at least 10 minutes during the hour between saves and by making a DC 15 Heal check.

A creature with the living construct subtype that would gain the stable condition instead becomes inert.


A dead character’s soul immediately departs the body, and getting it back into the body is a major hassle. Unless you have access to powerful divine magic, you can’t do much to a dead character except go through his pockets for loose gold pieces.


GM’s Note: If a character is at 0 hit points then their reserve points do not function in any way.

A disabled, stable, dying, or inert character has 0 hit points. Healing that raises her above 0 hit points makes her conscious and fully functional again, just as if she had never been reduced to 0. A spellcaster retains the spellcasting ability she had before dropping to 0 hit points, etc. (Of course, a character suffering from nonlethal damage equal to or in excess of her current hit points must still deal with the ramification of that state.) Take care however, because your wounds you got from this brush with death continue to be tracked and stack with later wounds you get from being knocked to 0 hit points again. Wounds only recover if…

  • You finish a “complete bed rest” (24 hours), which (after gaining your Fortitude Points for the rest) immediately triggers a regular Fortitude save (not an Injury Save, DC 10, +1 per 5 wounds) to reduce your wounds by half of the total of the Fortitude saving throw. If you fail the entire save, you still reduce your wounds by a quarter of your total on the saving throw. This option is not available to a living construct or quesar.
  • Once per day, a doctor can perform surgery on you.
  • Once per day, a living construct or one other creature (although they can benefit from aid another) can work on repairing that living construct.
  • If you are not immune to ability damage, someone can use a spell, power, supernatural, spell-like, or psi-like effect on you that is capable of curing ability damage of at least one physical ability score, after which they make a caster/manifester level check (same level as the effect, DC 8, +1 per 5 wounds) to reduce your wounds by half the result of the check (round down). While this method is much faster and easier, it’s resource intensive and heals no wounds on a failure.
Meta Analysis: The Death and Dying system introduces new considerations and risks to D&D combat. While you can’t necessarily die outright from “massive damage”, if a massive amount of damage brought you to 0 HP you have to make a number of rolls and you might still die from those rolls, but at least you get more of a fighting chance. Your Fortitude Points will likely save you the first time you go down, but will they save you the second time? The third? The GM has no idea, and might even be rolling damage in the open, and you should be scared of that.

Assuming you don’t die outright from being dropped to zero, relatively-easy access to healing magic means you can be back on your feet a lot quicker, but you still have those wounds, making you even more likely to die outright the next time you go down. Getting knocked down at all becomes even more of a good reason to flee immediately once you’re up, and odds are you’ll still have the shaken T condition from stress once you’re back up anyway.

The Heal skill becomes much more popular and useful, with its long-term care option becoming a frequent consideration after a hard fight. Magical effects which heal ability damage will also become much more popular as a faster option to remove wounds, even though they might be sometimes wasted since they’re being used on someone who doesn’t have any actual ability damage.

The Fast Healing ability acts differently while you’re at 0 hit points. It first heals any nonlethal damage as normal, but instead of then healing lethal damage it provides a +2 circumstance bonus on Injury Saves for every point of fast healing that would heal lethal damage that round. The Fast Healing ability reduces your wounds at a rate of one per hour. The regeneration ability has no additional effect in the Death and Dying system because if you were dealt lethal damage your regeneration can’t heal anyway, it wouldn’t make sense for it to heal your wounds.

No Massive Damage

Unlike the standard massive damage rules and the ones described by the original form of this variant, massive damage doesn’t apply in the usual sense in this setting. If you’re reduced to 0, you can still die outright as a result of failing the initial Injury Save by 10 or more, but an Injury Save doesn’t automatically trigger if you take 50+ damage and live through it.

Death and Dying

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