It is an oft-critiqued aspect of combat in DUNGEONS & DRAGONS that the difference between full health and 1 hp is nothing more than a measure of how close you are to falling unconscious, with no consequences regarding combat ability and resolve. While this suits many just fine, the complaint has endured throughout the various editions of the game. In this article, we will examine some options that you may include in your game to redress this.
Interpreting Health
A discussion about how to handle changes in hit points must needs start with a brief note about what hit points represent. This is a matter we have taken up before in our articles about narrating combat, and we leave the meat of the conversation for there, but it bears worth repeating some salient details.
First of all, hit points are not meat points. This has been a matter of some debate for many decades, prompting Gary Gygax himself to rant about the “preposterous” assumptions people have about the mechanic and how some people portray it as the number of times someone can be stabbed, set on fire, or the like. The Fifth Edition Player’s Handbook tucked a helpful sidebar on this, entitled ‘Describing the Effects of Damage’, on page 197, which reads as follows:
“When your current hit point total is half or more of your hit point maximum, you typically show no signs of injury. When you drop below half your hit point maximum, you show signs of wear, such as cuts and bruises. An attack that reduces you to 0 hit points strikes you directly, leaving a bleeding injury or other trauma, or it simply knocks you unconscious.”
This description shows the lingering influence of a mechanic that existed in the edition that shall not be named. That being: bloodied. Put in simplest terms, you were bloodied when your current hit points equalled half your maximum hit points or less.
Being bloodied was, in and of itself, meaningless, but it did often trigger things. Various powers (that is, spells, combat abilities, etc.) keyed on being bloodied or targeting a bloodied creature, and the players would have a sense of their progress in combat when the Dungeon Master advised that their enemy was bloodied. It is this feature that has inspired our variant rule for Fifth Edition, below.
Optional Rule: Degrading Combat
Using this variant, creatures begin to lose effectiveness in combat as they suffer damage. When a creature’s hit points fall below a certain threshold of their maximum hit points, they suffer a penalty to attack rolls, ability checks, and saving throws. These effects persist until the creature’s hit points have been raised above the threshold.
There are three levels of combat effectiveness: normal, fatigued, and wounded. You are fatigued when you are reduced to half your maximum hit points. You are wounded when you are reduced to one fifth of your maximum hit points. The effects of these levels are described below.
| Combat Effectiveness | Effect |
| Normal | None. |
| Fatigued | Proficiency bonus halved. |
| Wounded | Proficiency bonus reduced to 1. |
For example, a 4th-level rogue with 26 hit points would be fatigued at 13 hp and wounded at 5 hp, and a 9th-level wizard with 40 hit points would be fatigued at 20 hp and wounded at 8 hp.
This can be easily applied in combat by subtracting the regular proficiency bonus from the new proficiency bonus and applying the difference as a penalty to attack rolls, ability checks, and saving throws. For example, a 13th-level character normally has a proficiency bonus of +5, which would be halved to +2 when they are fatigued. Rather than recalculate all the attack rolls, saving throws, and ability check bonuses to account for the penalty, the character could simply subtract 3 (5 – 2). This can be tracked with a specific die, such as a d6, that is set aside as a reminder.
Optional Rule: Discombobulated
Being knocked unconscious is rough, and even with a touch of magic to help you back on your feet, you might be a little shaky after the experience. This optional rule applies a cumulative –1 penalty to attack rolls, ability checks, and saving throws each time a character is reduced to 0 hit points. This penalty disappears when you finish a short or long rest, or until the effect is removed with the use of a lesser restoration spell or similar magic.
Putting It All Together
The hit point mechanic is often misunderstood as some sort of health bar as in a video game as opposed to an abstraction of physical and mental resilience, tenacity, and skill in battle. Of course, some campaigns with a more heroic flavour or a greater emphasis on the grittier aspects of combat may choose to focus on a character’s hardiness and ability to take a beating, to the point where a mechanical effect is sought to justify the narration.
The optional rules presented here are intended for those who wish to apply penalties to combat performance based on hit points. It’s not a desire shared by everyone, and this article isn’t meant to convince anyone to either side of the debate. These rules are suggestions for how to implement the desired effect in a manner that is meaningful to the game without unbalancing it. Make of them what you will.
