| Some great ideas in this thread that might see some use in my games.
I like the idea of the wounding system but I'd like to keep it simple. I was thinking that any time a character fails a death save they gain a wound point (maximum of 1 per encounter). A wound point would represent -1 to attack, damage and skill check rolls as well as surge values. The -1 would not affect saving throws or the number of healing surges a day to limit the "death spiral". Wound points would stack so the penalties would begin to add up if characters were routinely being knocked down. To remove a wound point a character would have to have an extended rest and make a (DC 10 +1/2 level) endurance check. A successful heal check (DC 10 +1/2 level) would add +2 to the endurance check. A character could only recover 1 wound point for each extended rest which means a character who has taken a beating would be much less combat effective and might take several days to heal back up to full strength. My only concern would be that this might shorten the adventuring day significantly which would not be welcome.
Freeform rituals are good idea but I think I'd have the caster record the ritual and treat it as spell research. That way the extra cost for the initial casting could be considered a component of the research and you could roleplay the caster searching ancient tomes in great libraries if you wish. Future use of the new ritual should have a cost in line with other rituals of it's level. | 
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