This excerpt comes from a collection of alternate rules surrounding Dying, Death, and Divine Intervention. Once complete, the full collection will be submitted to Dungeon Master's Guild.
Taking Damage + Stabilizing
Bleeding Out
If a character is not killed outright after taking damage [see PHB “Instant Death”], instead of reverting to 0 hit points, the character retains a negative hit point (-1). A character with negative hit points is considered “bleeding out”, and will start making death saving throws [see PHB “Death Saving Throws”]. They will continue to make these saves until one of the following occurs: 1) They stabilize themself (3 successes), 2) They die (3 failures), or 3) They are made stable through other means (healing, Medicine check, party effect, other magic, etc).
A character is stable when they have exactly 0 hit points, and though they are not bleeding out, they are still unconscious. Stable characters do not make death saving throws. If a character is dropped to exactly 0 hit points after taking damage (no carry-over), they are immediately stable.
EXAMPLE: A Bard with 2 out of 9 hit points remaining takes 4 damage. Even though the carry-over damage is 2, the Bard has -1 hit points. Since the damage taken was not -(2+9), the Bard is not killed outright, and is instead bleeding out. At the start of their turn, the Bard will have to make a death saving throw. After the Bard rolls two failures, the Cleric is able to cast “Spare the Dying” on the Bard, which reverts them to 0 hit points and they no longer have to make saves.
If a character takes damage while stable, their wounds reopen or worsen, reducing their hit points from 0 to -1. They would then be bleeding out. If a character takes damage while bleeding out, 2 (or 1 if preferred) failed death saves are added to their count.
Medicine + Magic
When a character is bleeding out, there is a chance to stabilize them without relying on successful death saving throws: other characters or creatures performing a Medicine check or using magic. When in combat and within 5 ft of the bleeding out character, others may use their action on their turn to perform a Medicine check (DC: 10, though the difficulty is up to the DM). On a success, the character becomes stable.
Magic can also be used to stabilize. Spells or abilities that specify they stabilize a character [see PHB spell “Spare the Dying”] do just that - the target reverts to 0 hit points and they are stable. For spells and abilities that provide healing [see PHB spell “Cure Wounds”] or temporary hit points [see PHB spell “Heroism”], hit points are only added to the target if they are at 0. Once hit points become positive, the target regains consciousness. If the target’s hit points are negative (bleeding out), healing and temporary hit points first stabilize the character. A second spell or ability must then be used to increase their hit points from 0.
Example: A Warlock takes damage and her hit points are reduced to -1, leaving her bleeding out. A Cleric is too far from her to make a Medicine check or cast “Spare the Dying”, so he elects to cast “Healing Word” on her instead. Since the Warlock has negative hit points, the spell first stabilizes her, bringing her hit points to 0. On a Paladin’s turn, they can move beside the Warlock and use their “Lay on Hands” ability, adding 10 hit points and making her hit points positive. The Warlock is then conscious and has 10 hit points.
When out of combat, Medicine checks and magic can be used at any time.
What To Do When Stable
When a character is stabilized (0 HP), they enter a limbo state between life and death. While they are not aware of what is happening on the mortal plane or any other plane, they are aware that they can reach out for help from the beyond. If the character is religious, has an otherworldly patron, or simply admires a divine being, they may wish to try to contact that entity. An atheist, someone with a grudge against the gods, or someone who doesn’t want to be beholden to them might instead choose not to try to contact anyone. Refusing to acknowledge the gods or reach out to them for assistance could be regarded as insulting and blasphemous, but could also be seen as a brave and independent stance.
If a character is more desperate, they may elect to simply call for assistance from the first available interested entity. While this method is more likely than others to receive a response, it may not be the one the character is looking for - or an entity they want to meet.
Contacting Gods
Instead of simply waiting to be healed, a character at 0 HP has the opportunity to appeal to a favored otherworldly entity. Classes like Cleric and Paladin often reach out to the god they serve, while Sorcerers and Warlocks may try to contact the force that granted them their magical abilities. Such classes will have a better chance of contacting the entity they’re connected to compared to a class with little connection to the divine (for example, a Fighter Battle Master). Even though they have a lower chance of contacting someone, the “secular” classes can still have a favored god - whether it’s someone whose mission they respect, someone they fear, or someone their bloodline historically has worshipped. Though some characters may choose to not favor a divine entity, most will at least pay lip service to one in order to avoid being alone when on the brink of death.
If contacted, otherworldly beings can choose to answer the call or simply hang up. If a deity thinks itself too important to be concerned with the needs of mortals, it may decide to refuse an audience with the one who contacted it. Alternately, entities that enjoy meddling in mortal affairs or have a paternal sense of duty may speak with anyone who manages to contact them. Once in the presence of a deity, they can offer a variety of boons, curses, hindrances, information, and just about anything else in their domain. Since the most common encounters with the divine are when stable in combat, often the reward for contact is simply being restored to 1 HP. Depending on the god’s nature, though, they may also offer a boon, a blessing, advice, or simply a lecture before sending a character back into the fray.
Who?
Otherworldly beings are ranked into a hierarchy based on the number and devotion of their followers. A forgotten god without any followers has no control across planes and very little control within its own plane, which often inspires ambitious plans to gain devotees. On the other hand, powerful deities with thousands of followers to do their bidding usually have a high involvement in the affairs of other planes. Though they don’t have to work as hard to maintain their follower count, high-ranking deities keep a sharp eye on divine upstarts and will do everything they can to keep from being displaced.
Pantheon Structure
The majority of entities belong to a particular pantheon, though a handful prefer to go it alone. Gods belonging to the most popular and worshipped pantheons have more overall power, but each individual’s power is still heavily dependent on their personal rank within the pantheon (over-, greater, intermediate, lesser, demi-, and quasi-deities). For example, if there are more numerous and more devout worshippers of the Faerûnian pantheon than the Maztican pantheon, the top leaders of the Faerûnian pantheon will have more power than the top of the Maztican pantheon. Depending on the power difference between the two pantheons, a lesser deity like Azuth may have a similar level of power to an intermediate deity like Tezca, but it is unlikely a quasi-deity like Bhaal will be as powerful as Tezca. Naturally, the greater deities of less powerful pantheons are known to devise plots to weaken their stronger rivals.
Greater deities are respected and listened to by their lower ranks, while the lower ranks might have a hard time passing a message to or being granted an audience with someone above.
Major Gods
Major gods have the most devoted followers, regardless of rank. For example, though both Mystra and Lathander can be greater deities in the Faerûnian pantheon, if Lathander has fewer followers than Mystra and the top gods from other pantheons (Moradin, Corellon, Yondalla), he may not qualify as a major god despite being a fellow greater deity.
Major gods are the most frequently contacted due to the sheer number of their followers. Because of the reach of their power, major gods can often answer questions or grant abilities that those ranked below them can also provide, as well as ones beyond their scope of knowledge. Consequently, followers may reach out to major gods as a catch-all if they are not sure which specific lower-ranked deity suits their needs. Major gods are capable of granting the most powerful boons and deepest knowledge.
Minor Gods
The term “minor god” is used for anyone who does not qualify as a major god. They can be of any rank - they simply have fewer or less devoted followers than the gods who made the cut for major gods. In the example above, a greater deity like Lathander may be classified as a minor god along with lesser deities like Tiamat and quasi-deities like Bane, though he likely has more power than either of them.
Minor gods are usually contacted by those that have a specific purpose in mind or feel a more personal connection to them. They can grant boons and knowledge in accordance with their rank, but they are subject to the whims of their ruling deities. Further, minor gods can serve as intermediaries by relaying questions or pleas to others within their pantheon.
Other Otherworldly Beings
Those that are barely ranked within a pantheon (steps below even quasi-deities) are often called “spirits”, “demons”, or “guides”. This includes Selûne’s Slivers and Shards as well as celestials and fiends that serve and perform minor tasks for other gods such as lillends, couatls, unicorns, nightmares, hell hounds, and devils.
Beings that don’t belong to a pantheon are usually referred to as “others”, “outsiders”, or “rogue gods”. Their status may be the result of banishment from a pantheon or a voluntary decision to remain unaffiliated. This may include Ao the Overgod, Tharizdun, the Raven Queen, or a newly appointed deity without a particular affiliation. A Warlock pacted with The Great Old One is likely to be affiliated with one of these entities.
Though these beings are the most difficult to contact, there are many reasons why someone might choose to worship a spirit or outsider instead of a major or minor god. If they are the being’s sole worshipper, they may expect special treatment or the one-on-one interaction they likely wouldn’t get from a more popular god. Because of their personal beliefs, someone might trust an entity outside a particular pantheon more, and assume the outsider can give impartial information. Similarly, if someone wanted something the gods disapproved of (like slaying them all), they would prefer to consult a being that is unlikely to give the plot away. In more rare cases, someone may feel indebted to a particular spirit or sympathize with a banished deity, and their goal might be to exalt the weaker being to the power of a minor god.
When?
It is possible to contact deities even outside the unconscious stabilized state covered in the earlier chapter. Depending on the level of involvement of the gods in a particular game, places and objects with special significance to a god may facilitate contact and make it much easier to achieve.
Temple
A temple is any place of worship used by the followers of a particular deity. This can be anything from a large marble building to an altar on a riverbank or a cairn at the roadside. These places are infused with the presence of their deity and the devotion of their followers, creating a special connection for those hoping to make contact. Praying in a temple is the most common way to contact a god, but other methods may unfold as well.
Significant Locations + Items
Many gods have a connection to a particular location where a significant event occurred, or an object they had touched. Kiputytto may have a connection to Asram where she was slain by Talona, and Cayden Cailean could be connected to the Starstone Cathedral where he was made a deity. Those that wield the bow Ephixis may have a stronger connection to Nylea, and those with the bident Dekella may be closer to Thassa. Special locations and objects are much harder to find than temples, but they offer a greater chance of successful contact to those lucky enough to find them.
Special Circumstances
Over the course of an adventure, special circumstances may arise that warrant a change in the chance of successful contact with a god. If a deity is sealed away, their followers will no longer be able to contact them for boons and advice. If a deity drops significantly in rank, it may be much harder for followers to make a connection. In the same vein, if a deity dies or is supplanted and their powers are transferred to another deity, followers may struggle with the transition and find it difficult to draw on that presence. Followers of Shar or the Raven Queen who find themselves in the Shadowfell may have an improved chance of contact, but if they are in the Feywilds, chances may be lowered.