Like I said upthread, I really think that this is such a sticking point for so much of what D&Dnext is trying to achieve - not just healing, for example, but it's idea of "fiction engaging" stat checks as the default action resolution mechanic - that I think it should be tackled head on.some of us have talked in the past about how you can't make the Burning Wheel mechanism work in D&D very well, because there really isn't any incentive for risking failure.
That said, it seems more likely than not that it won't be.
This is interesting.So how about combining a death spiral wound system with bonuses to some positive thing?
<snip>
The more you suffer from the wounds, the more you are likely to get fate points. And critically, these fate points don't reset at the end of an adventure. They are a special kind of reward explicitly for pushing on in the face fo the death spiral--and they help you in ways that deal with being in a rough spot--whether you got there by pushing on or stumbled into it later.
The easiest version of Fate Points is as a +X bonus to any d20 roll, or to AC against one attack (+3 is probably a nice bonus).
Alternatively, if you want them to be of use only when in a tough spot, you might say that they can be used only to grant a +X bonus to AC (+4 might be a nice number) or to negate disadvantage on one d20 roll, or to negate up to -X of penalties (again, up to -4 of penalties might be a good number).
Then the question is, how are they earned? For succeeding at a certain sort of check while wounded? For attempting a certain sort of check while wounded? Or some other way?