I've looked at all the great advice and really thought about my goals, and here's what I've come up with. Maybe a little more complex than I'd like, but I think it fulfills my goals.
Hit Points, Damage, and Death
Hit Points in Alterra represent not physical wounds, but the ability to turn serious blows into a scratch, scrape, or bruise. So long as a character has at least a single hit point, he is not seriously hurt and will recover quickly. Resting for one hour will recover the character's level + CON bonus in hit points. This doesn't need to be sleep, but the character can't march with a load or participate in any strenuous activity.
Wounded
Once a character goes to 0 or below, they have been Wounded. A wounded character is in great pain, and is bleeding profusely. The following effects are in effect while a character is Wounded.
In order to cast a spell through the pain, they must roll Concentration DC 15 + Spell Level – current hit points. For example, a wizard with -5 hit points must roll (15+1-(-5)) 21 or better to cast the spell.
The character is limited to partial actions and cannot run
The character is weak and feeble, having a penalty equal to their current hit points to both attack and damage rolls.
The character loses all Dexterity bonuses to Armor Class and Ref saves.
The character loses one hit point per round from bleeding and pain.
To stop the bleeding, the character must receive some magical healing, or have someone make a successful Healing check at DC = 10 – Current Hit Points. Once the bleeding is stopped, the character must recover from their harsh wound. They still suffer all the other effects of being Wounded. Recovery from such wounds is not easy. Magical healing makes it nearly instant, but otherwise they will need a capable healer. Once per day, the healer can re-dress the wounds. This must be followed by 8 hours of rest. A successful roll heals one point for every point above 15 on the healing roll. So if the healer rolls a 20, the character heals 5 hit points. Once the character gets to 1 hit point or higher, they can regian hit points normally and are no longer wounded.
Dying
Once a character get to -10 – CON modifier – Level, they are Dying This number is known as the Death Limit. A dying character is greivously wounded. They are uncounscious and bleeding, and even if they recover they will not be the same. Once a character gets below this limit, they do not track hit points any more. After ten minutes, the character must make a Fort save DC = Death Limit or die. Every ten minutes the character must make another save at a cumulative -1 penalty.
To recover from dying the character must first be stabalized. Any magical healing will do this trick, restoring the character to one point away from their Death Limit. A Healing check with a DC = Death Limit will do the same thing. The character is still unconscious for 24 hours after stabalizing.
There are aftereffects for this as well. The character must roll a DC 15 Fort save or contract a disease from infection. If there were unsanitary conditions during the injury and unconsciousness the DC is 20. The character suffers one of the following injuries as well. The DM can choose based on the situation, or roll on the table.
1 – Weakness of Spirit (Lose 1 level)
2 – Muscle damage (-4 STR)
3 – Concussion (-4 DEX)
4 – Lingering Wound (-4 CON)
5 – Loss of an eye (-4 Spot Checks, -4 on ranged attacks)
6 – Limp (Movement reduced by 10 feet, cannot run or charge)
These injuries are permenant until the character recieves a Restoration, Greater Restoration, or Heal spell. They do decrease over time, however. Every level the character gains reduces the penalties by 1. Two levels will reduce the movement penalty to 5 feet and the character can charge. After four levels, the character moves at full speed and can run.
Depending on the exact nature of the wound, the DM may apply a more appropriate penalty of the same severity.
Spell Effects
Direct damage are not the only things that can cause a character to be Wounded or Dying. A spell that wound normally kill a character outright instead renders them Dying. It is more difficult to recover a character from a magical assault than a physical one. The Healing check is made at a -5 penalty. Further, magical healing must be carefully applied to correctly stop the arcane assault. The cleric must make a DC = Death Limit Healing or Spellcraft check or the spell is wasted. There is no risk of infection, however. Magical assaults inflict different Injuries than phsyical attacks do.
1 – Weakening of Spirit (Lose 1 Level)
2 – Wits Scrambled (-4 Int)
3 – Senses Dulled (-4 Wis)
4 – Haunted and Distracted (-4 Cha)
5 – Magical Suseptability (-2 on all saves vs magic)
6 – Soul Sundered (Character's spirit touched by death – Cure spells inflict damage, Inflict heals as if the character were undead)
These injuries are permenant until the character recieves a Restoration, Greater Restoration, or Heal spell. They do decrease over time, however. Every level the character gains reduces the ability penalties by 1. Two levels will reduce the Magic Suseptability by one, four levels will remove it entirely. A Soul Sundered gradually recovers. After 2 levels, the character partially recovers – cure and inflict spells work normally, but are halved. After 4 levels the soul is fully healed.
Note that this applies only to spells that directly kill a character. Otherwise use the weapon damage rules for spells that directly cause hit point damage.
Action Points
A character can use Action Points to help avoid the worst effects of injuries. Powerful heros are notoriously hard to kill. Using an Action Point will allow a Wounded character to instantly stabalize and act for 5 rounds with no ill effects. A Dying character can use three Action Points to instantly stabalize, but still must recover and suffer injuries from the experience.
The Boromir Rule
A Dying character can instead choose to go out in a blaze of glory. Seeing how much danger their friends are in, or that a hated enemy will be victorious, or even just a desire to make a final stand, they rise and fight for all they are worth. The character is considered unwounded for Cha Modifier + 3 rounds. The character can act normally during this time. Additional wounds cause great pain, but if the character makes Fort Save with a DC = damage dealt, they are unaffected. Once the time expires or the combat ends, the character collapses. After a few brief moments, the character is irrevocably dead.
