A Modest Proposal: House-Rule to D&D 5e Death Saves

            Fifth Edition's handling of death saving throws nagged me throughout most of my time playing it.

            Granted, a lot of things nagged me about Fifth Edition during my time playing it. I liked the system overall, but several things about it led me to house-rule it beyond all recognition into my own retroclone.

            For those of you who aren’t familiar with it, the D&D 5e Player's Handbook has the following to say about death saves:

“Whenever you start Your Turn with 0 Hit Points, you must make a Special saving throw, called a death saving throw…

Roll a d20: If the roll is 10 or higher, you succeed. Otherwise, you fail…. On your third success, you become stable. On your third failure, you die…. The number of both is reset to zero when you regain any Hit Points or become stable.

Rolling 1 or 20: When you make a death saving throw and roll a 1 on The D20, it counts as two failures. If you roll a 20 on The D20, you regain 1 hit point.

Damage at 0 Hit Points: If you take any damage while you have 0 Hit Points, you suffer a death saving throw failure. If the damage is from a critical hit, you suffer two failures instead. If the damage equals or exceeds your hit point maximum, you suffer Instant Death.” – Roll 20  Rules Compendium

            Although I like how simple the rules above are, I dislike how a “dying” character only has a chance of dying after failing two death saving throws. Therefore, “dying” characters aren’t really dying – they’re procrastinating.

Players at my 5e table initially reacted with horror when a character fell to zero hit points, but soon learned that it carried little risk after the first few times it happened. Rather than rushing to immediately help the fallen character, the players learned they likely had at least two rounds before any real risk raised its head. In sum, the rules-as-written provided tension only when a character failed two death saving throws, not when they fell to zero hit points.

            This might not pose a problem for you, but I found it irksome. Combat felt like whack-a-mole as monsters attacked characters and characters fell, then got back up again after stabilizing. Characters didn’t care much about rushing headlong into battle and getting knocked down, as they knew they had at least two turns for their allies to help them back up. Even if their allies were busy, they still could stabilize on their own consistently enough.

Combat in Fifth Edition sometimes feels like that Tubthumping song by Chumbawamba. Characters get knocked down, then get back up again...

            Of course, one solution to this could be for me (as the game master) to attack downed characters, giving them additional failed saves. However, I can’t help but feel like such a thing is a bit rude. I don’t want a reputation as a GM that kicks players characters when they’re down (literally).

Furthermore, attacking a fallen character often seems tactically disadvantageous for monsters. It would often be better for the players’ enemies to drop another creature than attack someone who (currently) poses no threat.

There was one instance where I had a ghoul attempt to drag off an unconscious character. In another, a bandit picked up a downed character to use them as a human shield as they retreated. However, all of that hardly discouraged my players’ flippant attitude towards falling unconscious.

            Tomb of Annihilation presents the “Meat Grinder” rule to make the DC of death saving throws 15 (rather than 10), but this only results in more failed saves. It does not solve the problem that a character at 0hp suffers no danger until they fail two.

            I also tried implementing the “Lingering Injuries” table found at the back of the Dungeon Masters’ Guide, providing a consequence for characters who fell to 0hp. However, I found that

1. Rolling on the table each time a PC fell proved cumbersome, and

2. The “lingering injuries” rarely proved so, as magical healing negated most of them immediately. They were more annoying than consequential.

            So, I implemented a simple house rule. Rather than roll a d20 for a death saving throw, characters roll their Hit Die. A result of 2 or greater counts as a success. If they roll a 1, they die.

            They still stabilize if they make three successful saves, but now they have a risk of dying each turn they remain “dying.”

            I’ll admit it’s a big deal, to tinker with the rules surrounding character death. Depending on the attitude at your table, character death might be a serious thing. So, you’re probably wondering: How does this house rule affect the probability of characters dying when they fall unconscious?

            Surprisingly, it actually makes them slightly more likely to survive.

            When a character in Fifth Edition falls to 0hp, they have about a base 60% chance of stabilizing on their own, not counting other characters healing or aiding them.

            I used this online calculator to find the probability of a character passing three death saves using my house rule, stabilizing after three successes. I found the likelihood for each Hit Die, from a d6 to a d12. (I'll admit I'm not fluent in probability, so if someone notices a mistake in interpreting these results - please let me know!)

            If you implement my house rule as exactly as described, magic-users have about the same chance of dying, while everyone else becomes less likely to die. If you harden my rule so that characters  die on a Death Saving Throw of a 1 or a 2, everyone becomes more likely to die except Barbarians.

Hit Die	Chance of Stabilizing (Death on 1)	Chance of Stabilizing (Death on 1 or 2)
1d6	58%	30%
1d8	67%	42%
1d10	73%	51%
1d12	77%	58%
*P.S. I’m not very well-versed in probability – so if you see something I miscalculated in the table above, please let me know so I can correct it.

            Also, to pre-empt the question of how to handle characters who take damage while lying unconscious and dying: currently, I rule that such a character must make another death saving throw each time they take damage while unconscious – still dying on a result of a 1. Instant Death also works the same way if the damage exceeds their hit point maximum.

            Obviously, character death and its role at your table is something to think long and hard about as a GM. I wouldn’t implement the above house rule lightly. However, I’ve found that using this system in my house-rule table makes it much more dramatic when characters fall in battle. The other players react by immediately planning on how to get the “downed” character back to their feet – or stabilized, at the least – as soon as possible. They know that, if a turn passes and that character rolls a death save, there is a chance, however small, that the character will breathe their last.

            Some Game Masters might balk at the idea that, once a character falls unconscious, they could die with a single roll. However, I believe that characters usually fall unconscious as a result of poor choices, poor luck, or some combination of both. Often, a lot of decisions and rolls lead up to a character falling unconscious and making a death saving throw. So I would argue that, with this house rule, a single roll doesn’t have the power to kill a character. They still fall unconscious when hit by an attack before dying, and their allies still have a whole round to help them. The benefit is that, in my experience, this house rule encourages players to make less decisions that lead unconsciousness, as the risks of doing so are higher.

            If you try this house rule in your own game or have your own suggestions, please let me know how it goes!