Celebrim
Legend
I was hoping to find some middleground where I could still have NPCs die in the PCs' arms when appropriate, while not pissing off healer players and providing some kind of rules justification. But maybe that's just not possible.
If you want a different game, change the rules of the game.
In my game, under certain circumstances - massive damage, struck by a killing blow when helpless, critical hits that drop you below 0, or falls that drop you below 0 - you must make a traumatic damage save. If you fail that save, you are subject not to immediate death - as in the standard conventional version of the game - but to some extremely harsh conditions.
For example, you might have a massive chest injury resulting in hemoraging. Under this condition, the DC of healing checks to help you increases, and cure minor or cure light wounds do not stabilize you. They aren't enough to stop you from bleeding out, because your wound isn't minor. Also in my game, multiple heals in a short time period do not stack. A second cure light wounds does you no good. So even the PC was healed, the players are fighting a losing battle to keep the NPC alive using these methods.
It would be quite easy to have even harsher conditions which might thwart even fairly powerful magic.
This gains me certain specific things compared to stock D&D (and it probably also involves giving up certain things, everything is a tradeoff).
One of those is that there are fewer immediate death situations. So, there are fewer cases where a player dies without prolonged drama and a chance to be saed. But also, there are cases where I can have the PC's attempts to save the life of a NPC be dramatic. And of course, there are cases where the PC's attempts to save the life of an PC or NPC are dramatic whether I intended it or not.
It's also worth noting that anyone who is dying is not automatically unconscious, but can make saving throws to remain conscious.
Now, the game is fair again. I'm not imposing my will on the players. I've given up some control of the game, but the game state that I desire is possible within the game world and I've attained it essentially without fudging, fiat, or dramatically increasing the possibility of PC death.
DM's don't have to be hidebound to a rule set just because some professional created it. But once committed to a rule set, they should adhere to it.
I disagree with the whole idea of "derailing" cause that implies a railroad which is not the end of the spectrum I lean toward. It's not about the DM forcing their plot on on the players - its about creating drama, gravitas, driving home a harsh blow as a sign of an enemy's brutality, or the heroic sacrifice of an NPC, or as a consequence of a PC choice, or failure at a quest.
I say this with full respect, but I can't help but see a lot of cognitive dissonance in those claims.