The Rule: whenever you’re brought back from unconsciousness you gain a level of exhaustion

The Reasoning: 5e combat almost necessitates yo-yoing from near-death expirience to battle to near-death expirience, all the time, without any consequence and it’s kinda lame.

People play DnD in all manner of ways, but I tend to focus my games around dramatic moments. We aren’t in high-RP mode all the time, but it pops up regularly. I think everyone in our group is a forum rp connoisseur, or an artist with dozens of characters, or a fanfic writer...

Why I say this is to establish that these people *love* character drama. But yet I found that even they simply get desensitized and taken out of the moment by the notion that 2 members of the party have Healing Word, so it wouldn’t even get to death saves. And it wouldn’t exactly be helpful to explicitly be like “please take this seriously, your life is in danger” when the rules clearly demonstrate it’s not. 

In my expirience some unsaid things have great effect on the presumed rules of engagement at the table.

Dramatically ramping up the difficulty of encounters and purposefully building them around the party’s weaknesses to make the encounter “feel more dangerous” is a very risky thing. Not only can you (and very likely at that) end up with a near TPK from a couple un/lucky rolls, you send a message.

The difference between:

1) the 4th encounter in a row, all entirely unrelated to each other, all attacking the group with an obscure type of damage that is the only type of damage no one has resistance to;

2) the understanding that going beyound your limit is physically taxing;

it is felt by the players. If all of their big guns are most of the time useless (by the dm’s design!) it brings a lot of animosity to the game and frankly, discourages from trying. We play this game to feel badass and have fun.

Another thing I like about it is that it starts slow, but you’re aware the upper levels are there, looming. As opposed to danger coming in a form of a crit on a special attack that just suddenly wipes everyone out (and let’s face it, 'but what if it crits’ is rarely on our minds, it’s like a 5% chance, pfff), this builds suspense. 

Now, I know that death yo-yo is a known problem with 5e. However, all the solutions to it that I heard of are often surface level. Like, for example - curbing healing word.

Healing word is a bonus action, 60f range, 1st lv spell. If you have at least one PC who has it, core rules as is, it does function a bit like a game breaker. If you were to try and get the fallen PC back up with a healing potion you would need:

1) to get to them, likely inviting opportunity attacks on your character;

2) sacrifice your action to feed them the potion;

3) and maybe most importantly, get that potion in advance! On lower levels that stuff is *expensive* and you probably only have 1 or 2 at most.

There’s planning, danger and sacrifice involved there. (Most of it also aplies to Cure Wounds, Healing Hands and the like)

Now look at Healing Word. You can get someone up often at no cost to your turn because bonus action abilities for most spellcasters are few and far between. But I still feel like banning healing word or making it a higher level spell just makes the situation... more annoying and not better?

Not to mention that at some point 2nd lv spells will become insignificant to your PCs too, and we have the same problem again.

(Someday I’ll write an equally long post on the ‘challenging vs bothersome difficulty’, but for now...)

TLDR: getting exhaustion from supernaturally bringing yourself back from the brink is intuitive, it’s an underused mechanic, it ramps up slowly but is still dangerous, costly to get rid of (long rest or potentially several 3rd lv Restorations), and can eventually kill you if you’re reckless enough. All of which adds appropriate narrative weight and danger that can be planned for.