The Death Saving Throw

Coming up on half a decade, the rules for Dungeons & Dragons 5th edition can no longer be considered ‘new’. The immense popularity of 5E cannot be overstated – the easy-to-access, fun-to-play rules have undoubtedly played a significant role in the recent resurgence of tabletop RPGs.

This doesn’t mean that the rules are perfect, however. In this first installment of D&D Thoughts, we take a closer look at one of the most debated rules of 5E Dungeons & Dragons: The Death Saving Throw. We’ll try to identify the problem with the core rule and offer our best house rules and advice on how to fix dying and death saving throws in 5E D&D.

If you just want to skip ahead to the house rules, you can find them summarized at the bottom of this post. And if you want get word when we post more stuff like this, launch new content, or have special promotions, sign up for our email newsletter!

The Dying Rules

Briefly summarized, the core rules of death saving throws and dying in 5th edition D&D are:

  • When reduced to 0 hit points, a character becomes unconscious and is dying.
  • A dying character makes a death saving throw at the start of each turn, by rolling a d20. 10 or higher is a success, lower than 10 is a failure. On the third success, the character stabilizes. On the third failure, the character dies. A 1 is counted as two failures, a 20 is counted as two successes.
  • A stable character doesn’t regain consciousness if it becomes stable, but is no longer at risk of dying.
  • A dying (or stable, but unconscious) character regains consciousness immediately if it regains hit points.
Death Dying 5E death saving throw house rules
“‘Tis nothing but a flesh wound – just gimme a second and I’ll be right back in there!”

You can find the full rules for death and dying in 5E on or in your Player’s Handbook (or anywhere else on the internet, more-or-less).

The Problem – playing whack-a-mole

Because even the smallest amount of healing brings a dying character immediately back to consciousness, combat can end up like more like a game of whack-a-mole than D&D, with the DM swinging away with a wooden mallet (or greatclub, more likely), while players go down briefly only to pop right back up again, not much worse for wear.

This ‘whack-a-mole-effect’ can negatively impact combat encounters for two reasons.

First, it greatly diminishes the consequences of being dropped to 0 hit points. As long as a nearby character has quick, low-cost healing available, such as the ranged, bonus action 1st-level spell healing word. dropping to 0 hit points is barely an inconvenience.

Second, as an extension of the first issue, the DM can feel forced to ‘play dirty’ by cutting off the pesky moles by the root, so to speak, by having monsters strike at downed characters with deathly intent. While that is a legitimate strategy, it can feel bad for both players and DM when characters are unceremoniously ‘executed’ while lying helpless and dying (“what, you are telling me people don’t like being executed? Gosh!”)

In summary, the lenient death saving throw rules are likely to either suck the tension out of combat and/or create tension between the players and the DM. So how to fix death saving throws and dying rules in 5E D&D?

The Solution – making 0 hit points count

Over the years, countless house rules addressing death saving throws have been put forward on discussion forums and blogs much like this one. Generally, house rules try to fix the issue by doing one or both of the following things:

  • Make it harder to resuscitate a downed character, or
  • Make being brought to 0 hit points have lasting consequences

Having tried many of these – such that a character needs to regain 10 hit points to be brought back, or failed death saving throws don’t disappear until you finish a long rest or come with a level of exhaustion attached – most end up being either too complex, too arbitrary, or too deathly.

There are, however, some that I find hit the mark better than others. Below are the two house rules that I’ve found works best for solving the issue with death saving throws in 5E.

House rule 1 – Remove Healing Word

The first house rule is simple: remove healing word from the game. In many cases, this simple change alone will reduce the DM’s frustration with death saving throws by half.

Healing word is a gamebreaking spell. Not because it’s any good in most situations – truly, it is kinda bad in most situations – but because it is the spell that makes the dying rules truly exasperating. As a ranged, bonus action healing spell available to three spellcasters (bards, cleric and druids), healing word is what truly breaks the death saving throw. If another character expends their action to bring another character back, you might think – “okay, at least it cost them something” – but doing it with a bonus action and a 1st-level spell slot can seem downright insulting. It goes without saying that features like Balm of the Summer Court (The Circle of Dreams druid subclass from Xanathar’s Guide to Everything) may also need to be altered or replaced, if you’re going down this path.

BONUS HOUSE RULE: Outright banning a spell can feel drastic for the players and make healing even less useful in 5E – which is bad, since healing is already only rarely a viable combat option (most often it makes more sense to deal damage than to heal people). You can make healing other characters prematurely (before they reach 0 hp) more attractive by changing how cure wounds work, as shown below.

This change (which is inspired by Pathfinder 2E) makes cure wounds much more versatile, and thus more likely that it will be used during combat. Characters can still heal as a bonus action, but not from far away, and they can still heal at range, but only by expending an action. Furthermore, if they spend their entire turn – both action and bonus action – characters can actually restore a meaningful amount of hit points to nearby allies.

Houserule 2 – Getting back into the fight

The second houserule is simple, but impacts balance a bit more: When a creature regains consciousness after having been reduced to 0 hit points, its speed is halved, and it can take only a bonus action or action on its turn, not both, until the end of its turn.

This one is a bit harsher on the players, without being overly harsh. Contrary to rules that prescribe a level of exhaustion for each failed death saving throw, or each time a creature is reduced to 0 hit points, this rule nearly always have an impact during combat, without long-term consequences that can mess up the pace of the session or adventure (other consequences, such as suffering levels of exhaustion, can end up being a pain for not only the player, but also the DM, who must change plans if a party rests prematurely, or adventures on greatly diminished).

Note also that since a character’s speed is halved during the turn they regain consciousness, they’ll have to expend all their movement just to stand up – or choose to crawl on the ground. This adds a bit more realism to 5E combat, since it’s – believe it or not – quite rare for even the greatest of warriors to rise from the brink of death, sprint full-on into a mob of monsters and make three greataxe attacks in the span of six seconds (though it’s pretty cool imagery, now that I imagine it in my head…)

House rules for Death Saving Throws – Summary

To sum up, the two house rules are:

  • Remove healing word (and other ranged, bonus action healing) from the game.
  • When a creature regains consciousness after having been reduced to 0 hit points, its speed is halved, and it can take only a bonus action or action on its turn, not both, until the end of its turn.

In my own games, I use both house rules simultaneously – the first rule makes healing downed characters more difficult, and the second rule makes sure there’s always an immediate consequence to being reduced to 0 hit points. However, even if used only on their own, both of these rules will make the whack-a-mole-effect in 5E less of an issue, so depending on how big you think the problem is, you can pick-and-choose the house rule you think works best.

A feature of these rules are that none of them significantly increase the actual deathliness of combat, but still increase the consequences of going down to 0 hit points, because it takes more time and effort to fully recuperate. This actively encourages premature healing (which is something that needs encouragement in 5E Dungeons & Dragons) without suddenly turning combat into a total party kill.

If you have opinions, questions, or suggestions (or want to chime to tell us which house rules you prefer), I’d love to hear from you in the comments below. And remember, you know best what works at your table, so if you don’t think these rules will make your game more fun – don’t use them!

J. A. Valeur
Eventyr Games

4 thoughts on “The Death Saving Throw”

  1. Matthew Vienneau

    Every time a character comes back from 0hp I give them a level of exhaustion. No one has gone past 4, but once you start slowing down (level 2) or getting disadvantage on attacks (level 3), the players notice. And it takes a few long rests to recover.

    1. Hi Matthew

      That can be an effective rule, indeed. Scary even! It is my own experience, however, that it often carries little weight in the combat itself (disadvantage on ability checks isn’t really a big deal in most combats), while it can become an almost derailing issue for the pacing of a good dungeon crawl, if players rack up 2, 3, or 4 levels, where they’ll flee the dungeon to take several long rests before returning.

      An alternative could be to apply a level of exhaustion immediately when going down, plus one with each failed death saving throw, but allowing characters to remove these levels of exhaustion with only a short rest, mimicking immediate fatigue/wounds more than long-term exhaustion. But hey, whatever works at your table is the right thing to do! 🙂

      J. A. Valeur

  2. Every time a character comes back from 0hp I give them a level of exhaustion. No one has gone past 4, but once you start slowing down (level 2) or getting disadvantage on attacks (level 3), the players notice. And it takes a few long rests to recover.

  3. I’m pretty sure this is in the rules of earlier editions, but negative HP was a thing, as was coup de gras. Healing Word can’t bring you up if you’re at -7HP from losing 10HP earlier when you were at 3. And although there’s been variations to this (negative HP equal to max HP; negative HP equal to 1/2 max HP; -10HP flat), breaking the negative threshold meant instant death (stabilization still applies when in the negatives though, except the penalty is losing -1HP per round plus any bleed effects).

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