Complex Death (5e Variant Rule)

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Complex Death[edit]

Under playstyle conditions, the rules have it that 0 hp is "unconscious and dying" for pcs. Each round, they make a death save, (DC10 on a d20, no applicable modifiers. In other words, flip a coin.) and three wins or losses results in death or stabilization at the end of the round. Take so much as 1 damage at 0, and die. Gain so much as 1 hp, you stabilize. Simple, clear, fast... and yet... rather static, anticlimactic, hollow, and boring. Let's liven up death a bit, shall we?

Cusp Of Death[edit]

The moment you drop to 0 hp, provided you do not instantly die, you must make a DC5 death save. The DC on this throw is increased by the damage exceeding your remaining HP when you were struck. (IE: If you had 3 HP and you received 8 damage, the DC would be 5+(8-3)=10.) If you succeed, nothing happens, you are unconscious as normal. If you fail, you fall unconscious with one death tick. If you roll 20, you fall unconscious with 1 tick of stabilization.


At the start of each turn where you are at 0 HP, you must save against DC 10 death. If you fail, you move one step closer to death, adding one death tick to your character sheet. If you succeed, you get closer to stabilization, adding one stabilization tick to your character sheet. If you roll 1 or 20, you move two steps toward death or stabilization respectively.

At the beginning of your turn, if you have three ticks of stabilization, you stabilize, regaining 1hp.

At the beginning of your turn, if you have three death ticks, you die.

If you start a turn with 3 ticks in both directions, you have an out-of-body experience where various spirits and visions try to entice you toward life or death. (This is best done by having two different people playing the two sides) If you choose life, you return to your body with 1 death tick removed. (Alternatively, flip a coin)


When someone ("the medic") uses medicine on you, ("the patient") they make a DC 5 medicine skill check. This DC is increased by 5 for each death tick on the patient. (Which results in DC20 on their last round before death.) The medic gets +1 on their check for each tick of stabilization the patient has. This skill check can be made with one of two objectives:

  1. The medic can fight to repair the damage itself by removing a death tick,
  1. The medic can fight to restore body function by adding a stabilization tick.

If the medic rolls 20, the objective is double-effective. (Removing 2 death or adding 2 stabilization.)

If the medic rolls 1, the opposite happens. (Adding a death tick, or removing 1 tick of stabilization.)

If the medic causes the patient to gain a death tick when they are already at 3, the patient dies instantly by their hand.

Thus, a single medic may have a chance of saving a life, if the patient does not worsen too quickly, and if they respond swiftly, but they will likely only delay the inevitable. Several medics working together on the other hand have a very high chance of successfully saving a life.

A medic can continue to use medicine on a stabilized character to remove death ticks, but failure results in destabilization, and a roll of 1 results in actually inflicting a death tick.


Once stabilized, you then need to consider recovery time. If they have no death ticks, it takes them a day to recover. If they have 1 death tick, it takes them a week to recover. If they have 2 death ticks, it takes them a month to recover. Multiply that by the number of times they have been "killed", indicating the long-term health impact that all of these severe injuries are having on the character.

If a character starts doing stuff while they are recovering, they will be forced to make checks for even simple actions such as opening a door. These simple action checks wiĺl have a DC equal to the character's number of death ticks +1 and ×5. All normal checks and attack rolls will have that DC added to their normal DC. Once they have recovered, their death and stabilization ticks are reset.

The Impact[edit]

The end effect puts a major focus on death itself, and the agony or suffering therein. It slows down gameplay at times, and can be excruciating for players to play through. It is best for slower-paced campaigns with harsher, grittier situations and a focus on character interaction over combat, lest the entire party spend weeks on end in bed.

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