Hit Points, Dying, and Death
Quite some time back, the estimable Tim Baker sent me this:
I had an idea for a topic or maybe even a series that you could consider covering in the future. I’d love to hear your take on damage, dying, and death in D&D (how’s that for alliteration?). Healing could be included in the topic, too. It’s an age-old question, but what are hit points?
How do different people interpret them, and has D&D interpreted them differently, either explicitly or implicitly, over the editions? What damage/death rules has D&D offered over the years? Optional rules? What about D&D offspring, such as Dungeon World’s “Black Gate” move when a character is dying? 13th Age’s optional “meaningful death” rule? D&D 4e’s optional wounds and recovery? 5e’s gritty healing optional rules? I think there’s a fair amount of variability to talk about, and maybe it could be tied back to the way these different rules impact the overall feel of the game.
Since we were just talking about this in the comments of my most recent article, I decided that I’d take a week off from the series on monks to tackle this. (Next week will be Unearthed Arcana, and I’ve got a new Plane Shift to cover.) Oh, and toward the end of this article, I propose a Wounds track to handle times when a wound shouldn’t heal overnight.
OD&D
Looking back to three-booklet OD&D, Gygax writes with the unswerving assumption that the reader owns a copy of CHAINMAIL, and thus doesn’t need any deeper explanation of hit points, death, or a whole lot of other topics. Rather than worry about digging up CHAINMAIL, I’m going to skip forward to the Rules Cyclopedia, which saves me from going through all of Mentzer’s BECMI individually. Hit points here are summarized as, “Your character’s hit point score represents his ability to survive injury,” and “an experienced character lasts longer in a fight or other dangerous situations”.
Many rules in the Rules Cyclopedia refer to natural healing, but if there are rules on the rate of natural healing in the book at all, I can’t find them. Characters normally die at 0 hit points, but there are optional rules (under a header for, perhaps ironically, “Keeping Characters Alive”) for 0 hit points being a “dying” state. The character makes a saving throw vs. death ray immediately upon falling to 0 hit points, and every turn (10 minutes) thereafter, and every time he takes additional damage. The character is dead-dead after one failed save. Still, this is the recognizable antecedent to 4e and 5e rules – note that this system doesn’t track negative hit points at all.
Magical healing looks pretty similar from OD&D on through 3.x, with some exceptions that I’ll note along the way. Clerics, and later other divine classes, with occasionally a Simbul’s synostodweomer or 3.x’s bard class for arcane healing, are your sources of healing with cure sucking chest wounds, raise dead, and so forth. The dice values for healing output have risen incrementally over the years, not really keeping up with increasing hit point totals and damage output.
AD&D 1e
In the 1e Player’s Handbook, Gygax goes to greater lengths to explain what hit points mean, probably because he got tired of explaining it in response to fan letters. Just a guess.
A certain amount of these hit points represent the actual physical punishment which can be sustained. The remainder, a significant portion of hit points at higher levels, stands for skill, luck, and/or magical factors.
I’m quoting this in detail because it’s the crux of the argument I plan to present in a little bit. So, you know, keep it in mind. Copy and paste it. Paint it on the walls of your gaming room. Whatever helps you out. But even having defined hit points as “skill, luck, and/or magical factors,” Gygax goes on in the 1e DMG to assert, “However, having sustained 40 or 50 hit points of damage, our lordly fighter will be covered with a number of nicks, scratches, cuts and bruises. It will require a long period of rest and recuperation to regain the physical and metaphysical peak of 95 hit points.”
Gygax is therefore saying that the heroics of large hit point totals are slow to recover. We could imagine that for some reason the 1st-level commoner takes a day to recover from nicks and scratches, while a high-level fighter takes weeks to recover from nicks and scratches, but for all that it would make my argument easy, I have to admit that that’s a spurious misreading of Gygax’s idea. Instead, he takes the fundamentally arbitrary view that the indescribable heroism of large hit point totals recovers slowly, even though you may not outwardly show wounds anymore. But since he’s asserted that 50 absent hit points – greater than 50% of the character’s health – doesn’t represent a missing limb or two, there’s no one major wound that should (in the simulationist sense) keep the character down for days.
He doesn’t make an exception for “what if the fighter lost all 50 of those hit points to one blast of dragonfire?” or the like. The undefinable heroism that Gygax requires weeks of rest (or a lot of healing spells) to restore could just as easily come back overnight, because skill, luck, and magical factors can do whatever makes for good gameplay – we don’t have outward signs of what they’re simulating.
Okay, enough about that. Let’s talk about just how slow 1e natural healing really is.
- You recover 1 hit point per day of total rest.
- BUT on the seventh day of rest, if you have a Con penalty, you deduct that from the amount you’ve healed. To be fair, the extreme example of a -2 hit point adjustment only shows up for a Con of 3. (There’s no benefit to having a Con bonus in the first seven days.)
- On the fourteenth day of rest, if you have a Con bonus (Con 15+), you add that to your total healed for that week. Repeat this on the twenty-first day of rest.
- Regardless of the number of hit points a character has, 4 weeks of continuous rest will restore any character to full strength. (sic)
In Which I Digress Somewhat
Guys, let me tell you something. This probably doesn’t come up a whole lot. What happens instead is the cleric player gets pressured to do nothing but cast healing spells and save spell slots for healing. Lord knows I saw this continue into 2e and 3.x, so I see every reason to believe it was a major part of OD&D and 1e.
- Day 1: Dear Mum, today we got our teeth kicked in as part of that good adventuring we was doing. Fortunately our cleric buddy, whose name I cannot be arsed to learn because it is degrading for a lordly fighter like me to have to learn the name of a first-aid kit, spent his sacred magic keeping our insides inside and our outsides in one piece. But we was still cut up pretty good at the end of the day, so we rested up. We did not heal any from natural healing, as you well know, mum.
- Day 2: Dear Mum, today our cleric buddy spent his sacred healing magic patching us back up. We are ready to go back to burning, pillaging, and doing those two things in a more appropriate order, because we are full of hit points, piss, and vinegar. Our cleric buddy looks sad and says that he has no more of that good sacred healing magic to keep our insides inside, &c. We could either rest another day, which is very boring and also won’t go super good because of 24 hours of resting is like eleventy billion wandering monster checks, or we could go have some fun and our cleric buddy could suck it up and just be the first aid kit that his gods made him to be.
My point with this little story is that a large percentage of the gaming populace was reluctant to play clerics for years, but every party needed them. Some number of the people reluctant to play clerics were uncomfortable portraying religious characters for reasons of their own personal convictions, but I’ll suggest that that was a tiny minority. The rest didn’t want to play clerics because they didn’t want to have all of these spell slots but get treated like a first-aid kit on the hoof – to have their main class resource demanded of them, when they have a ton of other spells they might like to cast today. (If you don’t believe me, I would go on to suggest that you are living in a very narrow segment of the broader gaming community, or you are kidding yourself.) At the same time, every party had to have a cleric, because healing is so vital to gameplay. This started to change in 3.x, but got completely revolutionized in 4e and 5e.
But I digress; back to death and dying in 1e.
1e has a Death’s Doorstep kind of rule (as 2e calls it), in which you’re unconscious at 0 hit points, bleeding to death at 1 hit point per round, and dead at -10. Any character can stabilize a dying character without serious difficulty. However…
You don’t just pop back up when healed, including when magically healed (with an exception for heal). Instead, you’re in a coma for 1d6 turns (remember, that’s 10-60 minutes), and must rest for a full week, during which time you can do nothing more than move slowly, eat, and sleep. In short, the adventure is 100% over for you. Go home, you’re lucky you get to keep this character at all. If the rest of the group wants to keep adventuring, well, that sucks for you, because you’re going to be sitting this one out.
Also, if you fall to -6 hit points or below, you might be horribly scarred or lose a limb or whatever.
I’m not sure if I want to call this ironic, but something very similar to this has come back into vogue in one particular area of gaming: tactical squad-based games where the player controls a large stable of characters, such as XCOM: Enemy Unknown, XCOM 2, and Darkest Dungeon. All of these are working within a consciously retro space, but their use of this mechanic is about pushing the player to have some depth to their bench, as it were – and to make sure that even victorious missions have consequences for anything less than perfect play.
Oh, and 1e definitely has the rule where getting raised from the dead costs you a point of Con; also you have to pass a Resurrection Survival percentile roll.
AD&D 2e
I don’t think 2e gets real fancy in ever trying to explain what hit points represent, or at least not in the core rulebooks, beyond acknowledging that hit points are a convenience and abstraction to make the game fun: “To allow characters to be heroic (and for ease of play), damage is handled abstractly in the AD&D game. All characters and monsters have a number of hit points. The more hit points a creature has, the harder it is to defeat.”
Natural healing gets more generous: light activity restores 1 hit point per day (which can include travel, as long as there are no fights or chases), while total rest restores 3 hit points per day, and at the end of each week you can add your hit point bonus from Con to the amount healed in that week. (There’s no reference to slower healing for low Con scores, though some readers may find it implicit.)
Charmingly, the Nonweapon Proficiency section of the Player’s Handbook flat-out contradicts this – having the Healing proficiency and the Herbalism proficiency grants the values listed above. I assume this was an editing error, in one direction or the other.
By default, characters are dead as a post at 0 hit points. The optional Hovering at Death’s Door rule in the DMG (which I casually assume that more than 75% of tables used, though I can’t back that up) involves unconsciousness and bleeding to death at 0 hit points and death at -10. Here I should really point out that damage output in 2e, for anything short of the really big dragons, is a lot smaller than what you might expect if 3.0 and later are all you’ve played. That 10-point threshold of death means a hell of a lot more here than it does in 3.0.
Anyway, if you get healed at all, you go to 1 hit point, and you are stuck at 1 hit point until you get one full day of rest (with, again, an exception for heal). Also, you lose all memorized spells, even with a heal spell. Falling to 0 hit points still ends this day of adventuring for you, though if the party can hole up for around 24 hours, you can get going again. This is a huge increase in the design emphasis on keeping the adventure and the fun going, rather than bringing it to a halt for one player, or everyone. Hint: we’re going to see that trend-line continue.
Here as in 1e, raise dead and greater spells cost you a point of Con, and involve a System Shock roll. This is the last edition that decides to die on the hill of, er, dying on a hill – that is, that wants permanent death to be on the line basically all the time. Oh, sure, there are permanent death effects in 3.x, but they’re special monster effects or corner cases, not baseline rules.
3.x D&D
This edition goes back to some of Gygax’s explanation of hit points:
Hit points mean two things in the game world: the ability to take physical punishment and keep going, and the ability to turn a serious blow into a less serious one. For some characters, hit points may represent divine favor or inner power. When a paladin survives a fireball, you will be hard pressed to convince bystanders that she doesn’t have the favor of some higher power.
Because hit points represent your capacity for avoidance, there are coup de grace rules for when the defender is helpless. Note that with larger Constitution scores and modifiers possible, and with full Hit Dice values continuing above 9th or 10th level (unlike in earlier editions), hit point totals in 3.x are comparatively stratospheric, and damage gets rescaled somewhat to match… but that’s a topic for another day.
Natural healing has bumped up to 1 hit point per level for a full night’s rest, or 2 hit points per level for a full day-and-night of rest. This is starting to acknowledge the 2e oddity that a 1st-level fighter can’t really need more than 14 days to heal at 1 hit point per day (and even that is unlikely), while a high-level fighter might take 3-4 weeks and still not be at full hit points. Instead, hit points healed scale by your character level, just as your maximum hit points do. Of course, since you regain no hit points if your rest is interrupted, and DMs seem to love nothing so much as a nighttime campfire attack, you don’t want to go to bed with any hit points missing – then you’re both facing the encounter in a weakened state and not recuperating. But since the game isn’t really playable without a primary healer or a whole mess of wands of cure light wounds in the party, most players never directly encounter the natural healing rules. In the twelve years that I played and ran 3.x and 3.x-adjacent games, I would guess that PCs recovered hit points through natural healing (not counting nonlethal damage) fewer than half a dozen times. We should have topped off hit points with natural healing more often, but never bothered to learn the rule… and that full-day-of-rest thing was just never going to happen.
I guess I should talk about the wand of cure light wounds and how it became a logistical answer to the cleric’s gameplay problem. 50 charges, caster level 1, spell level 1, so 750 gp, or 15 gp per 1d8+1 – after a certain point in the game, which is probably at or around 5th level, this is the way to keep your party healed. When it runs out, buy another, because that’s 3.x for you. Oh, sure, good and neutral clerics can spontaneously cast healing spells, which means they can prepare more exciting spells… but who wants to dump the exciting spells for healing once you’ve made that choice? No, go for the wand.
Characters are Disabled at 0 hit points (only bleeding out if they try something strenuous), bleeding at 1 hit point per round from -1 to -9 hit points, and dead at -10. With these larger damage totals, it’s entirely likely and common to go from hurt but still fighting to completely dead in a single unlucky hit (such as a x3 crit or a big evocation). House rules and 3.x-adjacent variants generally expand this range, as with Pathfinder’s “negative amount equal to your Constitution score,” and Arcana Evolved’s somewhat more complicated values (since AE also expands the Disabled range).
A dying character has a 10% chance to stabilize naturally each round, and also stabilizes with a successful DC 15 Heal check, or with even 1 point of magical healing. If you’re healed back to positive hit points, you’re fully functional again. No lasting cost, except for the 15 gold pieces for that cure light wounds charge.
Raise dead and resurrection cost treasure and a character level, or if you don’t have any character levels to lose, 1 point of Con. Falling behind in XP feels absolutely awful, though, and by making you weaker also makes you more likely to be the next one to die. It’s a long-form but intensely literal death spiral. True resurrection costs a whole lot more treasure, but dodges the XP loss. So yes, that’s the one you want. (Though in 3.x, cash is also a progression mechanic for your gear, so while it’s less visible, you’re still suffering a permanent loss of some kind.)
4e D&D
This edition declares (as is not the least bit controversial by now) that hit points are “more than physical endurance” and represent “skill, luck, and resolve.” The bigger shift is in magical and natural healing, though I’ll need to drill down to exactly what we mean by “natural” here. In 4e, characters have healing surges, which represent their own capacity to recuperate. Healing surge values scale by level. Most of the common forms of healing involve spending a healing surge, regaining hit points based on your healing surge value (possibly adding a few d6s to that), and going on with the fight.
All characters have a self-heal called Second Wind, and every leader class has a ranged heal that they can use twice per short rest (this number eventually goes up). Most leader classes also have daily utility or attack powers that let one or more characters heal, with or without spending a healing surge, and so on. Once you’re out of healing surges, there aren’t a ton of ways to recover hit points. Importantly, the core healing feature of each leader class spends uses out of a pool that can’t do anything else, and uses a part of the action economy that most of their other powers don’t need. If you want to pick up the few additional healing features with your utility power slots, that’s on you, but the game doesn’t put a ton of pressure on you to do so.
This is where “natural” healing starts to get hinky. A warlord’s healing feature is not magical, within the game’s fiction – it’s a surge of restored hit points that are about restoring lost resolve. That’s also the fiction behind a lot of temporary hit points.
What we usually mean by natural healing, though, is also part of the game. During a short rest, you can spend as many of those healing surges as you want to replenish your hit points, and since each healing surge is roughly a quarter of your total hit points, it doesn’t take a lot to figure out that you can heal yourself from nothing to full hit points more than once in a day. (Classes gain varying numbers of healing surges depending on their role – the more you get punched in the face for a living, the better you are at shaking it off.) At the end of a six-hour extended rest, you recover all hit points and all healing surges – you’re always ready to go the next day.
4e introduces death saves as what you do while you’re dying, rather than ticking down negative hit points. There are a lot of design reasons for this, starting with negative hit point accounting being sort of dull, and also taking the pressure off of the conscious PCs to aid their dead companion – even if you don’t go for transparency in hit point totals, 3.x PCs know they probably have several rounds to get to you before you’re dead, and it’s usually better to finish the fight before worrying about you.
Failed death saves accumulate between extended rests. Any three failed death saves – even with healing between them – mean you’re stone dead. Successful death saves only forestall the inevitable – no change in your condition. Only on a death save result of 20 or higher (possible through magic items or various powers) do you stabilize and heal. You also die if your current hit points are less than or equal to half your hit points as a negative number. (That is, if you had 100 hit points, you are dead at -50, or at 3 failed death saves.)
Getting raised from the dead takes a ritual, and that ritual’s cost hinges on your current tier (heroic, paragon, or epic), because the Raven Queen or other death-god is more interested in keeping you on as a house guest if you’re famous. Heroic characters cost 500 gp to raise, which is expensive but not unbearable, while paragon increases by an order of magnitude, and epic does as well; considering the treasure scaling of 4e, this is wisely done. 500 gp is rounding-error cash to an epic-tier character here. To stop death from being a total non-event, the newly-restored character has a -1 penalty to all attacks, checks, and saves for three milestones (six encounters). That’s, um. Not a lot.
In most regards, 4e is the high-water mark of getting rid of every kind of impediment to playing the next encounter and letting the game move along. Tim asked about optional wounds rules; while I’m not aware of an “official” version issued by WotC, there are enough community-created house rules for wounds that I’m not sure where to start. Sorry, Tim, I’m skipping this one.
5e D&D
“Hit points represent a combination of physical and mental durability, the will to live, and luck.” Since there’s nothing objectively observable in real life about any but the first of these, I think it’s just as reasonable to imagine that a character regains their mental durability, will to live, and luck after resting as over any other span of time. (Lost reserves of mental durability and luck suggest that any stressful situation, including failed social encounters, might plausibly cost hit points, though 5e doesn’t follow through on this.)
Natural healing works in both short rests and long rests. In a short rest (one hour), characters can spend Hit Dice (and add their Constitution modifiers) to regain hit points. This is the first time in any edition that Hit Dice are something you expend, in addition to being how you calculate your hit points. A bard’s Song of Rest gives this a big boost. The Healer feat also allows creatures to be healed for 1d6 + 4 + the creature’s maximum number of Hit Dice. The feat’s ability to help you is renewed when you complete a short rest.
Long rests restore all of your hit points and half of your maximum hit dice. This means that you have the hit points you need to go get in trouble, but might be missing a bunch of the recuperative ability to let you keep doing it.
Taken together, these natural healing rules greatly reduce the healing burden on spellcasters. Only the Life cleric stands as a pre-eminent healer in the Player’s Handbook subclasses; otherwise, clerics are on roughly equal footing with bards and druids. Thanks to the reduced healing demand, even paladins could potentially serve as a party’s primary healer. This is a huge boon to the whole experience of playing any of those classes.
At 0 hit points, a character begins dying, rolling a death save each round on their turn. A successful death save is any roll of 10 or better on a d20. Three successful saves stabilizes you, three failed saves kills you, a natural 1 counts as two failed saves, and a natural 20 restores you to 1 hit point and consciousness. Taking damage immediately causes a failed save, and critical damage (such as the automatic crit of an adjacent creature hitting you with a melee attack) causes two failed saves. Oh, and if you take enough damage that you would go straight to your negative hit point total, you die (this is not common, except maybe in very long falls). A stable character that isn’t otherwise healed regains 1 hit point after 1-4 hours.
There are a variety of options for restoring the dead to life. Revivify is for when they’re only barely dead; it is comparatively inexpensive and non-traumatic. Raise dead is 200 gold pieces more expensive, and leaves you with a penalty to attacks, saves, and checks that fades over the course of your next four long rests. It’s one of the only cases of a flat numerical penalty to rolls as the result of a temporary effect. Reincarnate is another 500 gold pieces more expensive and is exceedingly likely to race-change you, but it’s not otherwise traumatic. But hey, at least all of the possible races are bipedal humanoids with rules in the Player’s Handbook in this edition! Resurrection is also expensive and traumatic, but has much higher tolerances for dismembered bodies or the creature having been dead a long time. Then there’s true resurrection, which is 25 times per expensive than resurrection, but has far more generous parameters on how long the target can have been dead (up to 200 years) and how much of the body you need (none whatsoever, if it has been destroyed). Dead for a long time and trapped in Grazzt’s backyard? No problem!
There are also a handful of optional rules in the DMG for slowing down (8 hour short rest, 7 day long rest) or speeding up (5 minute/1 hour) resting, and for changing what you get from completing a long rest (Slow Natural Healing – you recover no hit points through a long rest, only Hit Dice). The text calls out that Slow Natural Healing is for “grittier, more realistic” campaigns without the benefits of magical healing. Let me tell you, Slow Natural Healing would mean a lot less in a party with a bard or a Life cleric. Also, spoiler, I am going to offer some additional healing and suffering-not-getting-healed options in this article.
Now for a quick survey of D&D-adjacent systems.
Dungeon World: The Make Camp move restores half of your maximum hit points and consumes rations; consuming rations is a bigger deal in DW than in D&D. The Last Breath move gives you a chance to avoid death or make a dire bargain with Death. Clerics also have a Resurrection spell that is costly, possibly extremely costly. Death is definitely not a joke in DW, but hit point totals are also small enough that your worst case short of death is two days of rest.
13th Age: This game’s approach to natural healing is largely subsumed in its mechanics around pacing – after every four encounters, you get a full heal-up. Full stop. (You also have healing surges for in-combat healing.) If you take a full heal-up before you should, it costs you a campaign failure, which means whatever the situation at hand says it means.
The most interesting bit is the rules around the cleric’s Resurrection spell. You can cast it a certain number of times in your whole career. It starts off quick and easy, and gradually becomes slow and costly – the fifth casting costs you your life, and has only a chance of restoring your target. Since it’s a 7th-level spell anyway, this intersects a little oddly with what may be only a few remaining sessions of the campaign.
There are also optional rules for lasting-wounds (sic), which reduce your maximum hit points until you clear them on a full heal-up. The optional Meaningful Death Rule stipulates that only named villains can kill PCs; any time you would otherwise be dead, you instead slip into a coma until your allies bring you out of danger. I want to emphasize that interpreting this from a simulationist perspective is meaningless. 13th Age is nothing if not an opinionated game, and it is impressionist and gamist rather than simulating anything at all.
Adventurer Conqueror King System: Severe wounds (that is, being deep into negative hit points) require a roll on the Mortal Wounds table, which has a pretty good chance of killing you on the spot. There are all kinds of permanent drawbacks that can come from this table, many of which may leave your character so mangled as to be unplayable in your current class. You can then try to get someone to fix these things with magic, which forces a roll on the worryingly-named Tampering With Mortality table. (I’m sure it’s fine.) The results here are more spiritually gruesome, but there are a small number of beneficial outcomes as well. All told, this is cool and flavorful stuff, though I would tweak a few results for personal taste. Adapting it into 5e would take some thought, on account of a lot of small penalty values that 5e mostly rejects as an approach (or, you know, you could just deal with it).
Wounds System for 5e
Over in Harbinger of Doom, I created a collection of Alternate Threat Tracks to parallel 5e’s Exhaustion track. I propose to do the same with Wounds, a subsystem that allows longer-term wounds that increase your risk of catastrophic failure (i.e., death), but let the adventure go forward rather than grind to a halt, and don’t increase the burden on the healers to spend a whole day of spells healing you.
- Gain a Wound when you fall to 0 hit points.
- Optionally, gain an additional Wound each time you fail a death save.
- When you roll a natural 20 on a death save, one of your Wounds wasn’t really that bad after all.
- Heal a Wound when you take the Recuperate action.
- Heal, mass heal, and regenerate each immediately heal one Wound.
Wound Level | Effect |
1 | Your maximum hit points decrease by an amount equal to your character level. |
2 | Your DC for death saving throws is now 13. |
3 | You gain one level of Exhaustion that you cannot remove through rest until your Wound level drops below 3. |
4 | When you regain hit points from magical healing or spending a hit die during a short rest, you regain half as many hit points. |
5 | Your DC for death saving throws is now 16, and you gain a second level of Exhaustion that you cannot remove through rest until your Wound level drops below 5. |
6 | When you leave initiative order (at the end of an encounter), and when you begin a long rest, roll a death saving throw. If you fail, you immediately fall to 0 hit points and begin bleeding to death. |
As you see, this draws significantly on the Exhaustion table. There’s actually no reason you couldn’t use the Exhaustion table for this, but track Exhaustion (which is easy to gain and easy to lose) and Wounds (much harder to heal) separately. I’ve deliberately avoided having Wounds kill you outright. Instead, they sharply increase the odds that something else will get you, but an attentive healer can keep you alive, even if it means some meatball surgery in the 4077.
This optional rule is not for all campaigns, possibly not even for very many campaigns, but I think this or something like it is a better solution to lasting wounds and carrying over injury from one day to the next. It’s good for death to be meaningful in games, but getting knocked out of commission for multiple encounters is a recipe for that player to have a miserable game session.
Conclusion
The general statement of what hit points represent in D&D has, to my surprise, changed barely at all since Gygax wrote the 1e Player’s Handbook. A cursory glance at D&D memes and conversations around the game suggests strongly that a minority of players have read and internalized the idea. Hit point totals have changed, and 2e to 3.x was a huge mathematical shift that had all sorts of obscure knock-on effects, but overall, this is pretty consistent.
The rules around death and dying have gone through all kinds of changes, on the other hand. There’s a steady trend-line of designers trying to avoid situations that stop the flow of the adventure, or block a player from having fun. Balancing narrative stakes against not wanting to get kicked out of having fun is incredibly tough, and I’ll take this opportunity to remind readers that threatening the characters with death is usually the least interesting option – when you carry through with that threat, they can’t keep struggling with the problem (unless you’re in Ghostwalk), but if you systematically destroy everything they love… well, the Feels Train keeps on chugging.