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Message: <blockquote data-quote="VannATLC" data-source="post: 5950304" data-attributes="member: 60935">As far I've been able to determine, most people don't like Death spirals.I've suggested in a few other places that when somebody is reduced to under 0 hitpoints, they suffer a reduction in their maximum hit points, and to their maximum hit dice. In 4e, I used this, and it required significant rest or ritual healing to restore to their original numbers. I also added made their death save failure penalty equal to their  remaining healing surges. Worked fine, no death spiral, still long lasting injury. Hit points and attack characteristics are far too abstracted to put penalties on rolls, imo, but reducing your overall survivability seems to fit the same abstracted idea.</blockquote>