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Message: <blockquote data-quote="Rod Staffwand" data-source="post: 7323758" data-attributes="member: 6776279">I did this in my first 5e campaign, but only when the PCs took long rests in dungeons or other hazardous environments where attrition would rightfully take its toll. However, like others have pointed out, players tend to just compensate with more clerical healing. I didn't see where it had much of a benefit to anyone's enjoyment of the campaign.If I ran that campaign today, I'd probably just only allow long rests in towns and other places of safety. It gets to the attrition theme much better by giving the party a good, understandable goal (get back to town!) in order to heal up.On the other hand, our sporadic beer and pretzels game went with death at 0hp. And while it wasn't necessarily gritty (there was A LOT of beer), I would absolutely use that option in a serious campaign if I wanted to play up the danger aspect of combat.A good half-measure would be getting a wound with each death save. For simplicity, I crib from the MM and reduce the PCs max hit points by 1HD or so. Multiple wounds stack, naturally. Recover time: let's say 1 week per wound. Reducing max hp gives the player some noticeable pressure, but doesn't gimp the PC with annoying penalties that will get old fast.</blockquote>