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DM Advice: The merciful medicine check

I was browsing r/DMAcademy and came across a post titled "Killing a Party Member with a Medicine Check?" Juicy.

The long and short of it is that a monk had failed two death saving throws and, due to lack of available healing resources, the barbarian tried a Medicine check to stabilize the dying monk. He rolled a natural 1. The DM that created this post remarks (emphasis mine):

I realize I could have (and with how I normally [handle] critical fails, probably should have) said that the barbarian accidentally gave the monk a death fail, which would have killed him. But in my omnipotence, I chose to be merciful, and just said the barbarian's attempt failed to stabilize our monk. The cleric then succeeded on a medicine check and saved the monk.

This scenario highlights why it is crucial to understand Rules as Written (RAW) before riffing off of them. The table was playing with a house rule that introduces some form of Critical Success and Failure or Critical Fumbles, ala Dungeons and Dragons 3.5e, perhaps without even acknowledging how D&D 5th edition RAW treats ability checks.

I think the DM handled this situation "the right way," although what's "right" will vary drastically between individual Dungeon Masters and tables. It just so happens that choosing to be merciful in this scenario and going against the Nat 1 chaos was intuitively following RAW. As far as RAW is concerned there is no chance of accidentally killing your ally when performing a Medicine check to stabilize them. The threat of the resulting natural 1 imposing a fail on the monk's tally of death saving throws is contrived purely by the DM and the prevalent culture of "bad stuff happens on Nat 1." For more on how RAW doesn't support critical failures and successes on ability checks take a look at my related article: How the collective fascination with Nat 1 and Nat 20 disregards RAW.

The official 5e ruling can be found in the Player's Handbook (PHB):

Stabilizing a Creature The best way to save a creature with 0 hit points is to heal it. If healing is unavailable, the creature can at least be stabilized so that it isn't killed by a failed death saving throw. You can use your action to administer first aid to an unconscious creature and attempt to stabilize it, which requires a successful DC 10 Wisdom (Medicine) check.

PHB. pg 197 | Combat

Even so, to shield the monk from death this DM had to make a sacrifice. They sacrificed, for just a moment, consistency. At that table natural 1s are typically treated as critical failures, so the party may have braced themselves for the inevitable. They had screwed up. What if the monk was a goner because of it? When the DM broke consistency and made the choice to spare the monk the party may have been relieved, surprised, or both.

For some groups the monk dying by the well-meaning barbarian would have been a special moment, consistent with how their world works and true to the fickle ways of the dice gods. For other groups, to have a character die to something that's not even logical by RAW could be very upsetting. I can't hope to know how this particular group plays and feels, so I won't even try. Either way, this DM felt conflicted about their ruling and sought council on r/DMAcademy to discuss.

A talking point the original poster made was this:

I like all decisions to have possible negative results, rather than just be benign fails.

This point seems to overlook some core functions of being reduced to 0 hitpoints and what it costs to stabilize a creature. The barbarian made the decision to try a Medicine check to stabilize his ally. The "negative" results that come with a failure are implicit. No additional punishment needs to be added to heighten the stakes. A failed check means the downed ally is still rolling death saving throws. Narratively, the medic failed basic first aid and is watching their comrade die because of their failing. Mechanically, it means the downed character is still at the mercy of death saves and could easy die to a multiattack or bad rolls.

If they were actively in combat (which they were not) choosing to make a Medicine check would have been a truly weighty decision to make. Per the rules, administering medical aid costs an action. Actions in combat are a premium commodity and to spend one trying to save an ally is noble. Thus, the high cost to act combined with implicit negatives of failure make a Medicine check plenty meaningful on its own.

Outside of combat, if initiative order is maintained, the threat of the character slipping away on their next death save is enough tension to make a Medicine check count. When initiative order is abandoned, the DM could adjudicate that, given enough helping hands and attempts, success is inevitable and rolling is therefor unnecessary. If the Dungeon Master isn't prepared to follow through with what a failed Medicine check could mean then they should avoid rolling at their own risk. Otherwise, failing and repeatedly trying until successful can cheapen a tense moment. Alternatively, if rolling is too fun to ignore I recommend calling for one roll and using the result as a narrative jumping off point for describing how harrowing the experience of trying to stabilize a dying ally is.

The two big takeaways from this spiel are:

  1. Know RAW and the implications of deviating from RAW before implementing house rules

  2. Understand the core concepts of resource cost and the built in consequences of failure

All that said, the DM in this example runs their own table and, presumably, plays the way their table enjoys. Their ruling was fair and good. I thank them for this thought exercise and wish them many grand adventures!


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DM Advice: Use choice. Not force.

Player agency is everything in a TTRPG. Avoid forcing the party into a situation and instead learn to give them choices within the scene!

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