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Message: <blockquote data-quote="CapnZapp" data-source="post: 6916253" data-attributes="member: 12731">The former.Everything keeps working like in raw, except you count down to -10 instead of 0.When you have 12 hp and get 19 damage, you're at -7 and dying (instead of at 0 and dying). Making it a good idea to spend something more than just a first level Healing Word if you want to rescue your ally from death saves (and unconciousness).So, if you're at -7 and dying, and take another 2 points of damage, you go from -7 to -9 (and that counts as a failed death save just as you'd expect).Instant death also works exactly the same: if you have 15 hp maximum, you die if you take 15 damage when you are already at zero or below.The only change is that you keep track of negative hit points down to -10.</blockquote>