The following post includes my current revised/suggested house rules for Death and Dying in Fourth Edition Dungeons & Dragons:

“In the unending exploration of the unknown and the fight against monsters, death looms as a constant danger.”
–Death and Dying, PHB

Every character has a number of hit points and healing surges, which represent their current physical, mental, and emotional well being, the state of their morale, or what could be called their “spiritual” well being, as well as a number of other natural and supernatural effects that remain to be describe.

When a character sustains damage from an attack, they lose some number of hit points, which represents attacks on their body, their mind, and/or their spirit. This doesn’t mean the character has necessarily sustained a wound, and a loss of hit points may in fact represent the character successfully avoiding injury.

Once a character has sustained damage sufficient to reduce their hit points below the halfway mark (let’s say they have 30 hit points and they’ve taken 16 points of damage) they become bloodied, which represents the first outwardly noticeable sign of injury or fatigue. The bloodied condition has no inherent effect, other than to be a marker.

Bloodied (status effect)
* No inherent effect, other than to denote that you have fewer than half your maximum hit points remaining.
Modified Conditions for December

Some powers or other effects are keyed to the bloodied state, such as a character’s bloodthirsty nature kicking in and granting them various combat advantages, or the survival instinct of another becoming more intense as they feel their life endangered. Some powers may treat a target as “effectively bloodied,” even if they aren’t.

Once a character’s hit points are depleted (as in, less than one remaining), they continue to sustain damage, but now suffer from a second status effect, which we’re going to call wounded. Characters who are wounded must make a saving throw at the end of each turn, against a condition we’re going to call helpless.

Wounded (status effect)
* During an encounter, you must save against becoming helpless at end of each of your turns.
Modified Conditions for December

(I’m not going to describe how to make a “death saving throw,” mostly ’cause it isn’t necessary for anyone who already knows how to play the game, and I don’t want to incur the wrath of anyone on the Hasbro/Wizards of the Coast legal team for actually publishing some of their game rules.)

Should a character stack up a number of negative hit points equal to half their maximum hit points, they immediately become helpless. Should they fail three saving throws against helplessness before they take their next extended rest, they are rendered immediately helpless. You keep failed saves between encounters.

The dice should never be used to determine if a character lives or dies. The choice should be left up to the individual player, the game master, and/or the gaming group as a whole. Helplessness can represent everything from unconsciousness, to becoming cursed, to the state of having one’s heart, soul, or dreams stolen.

Helpless (status effect)
* Can’t use any actions, including free actions. Can’t use any powers.
Modified Conditions for December

What happens to your character to end the Helpless effect is beyond the scope of the game at the current time, though I intend to address it with coming updates. Primarily, the choice of a State enables a character to “cheat death” by assuming a form that allows them to operate in a limited manner while they’re Helpless.