# How do you decide if a disease is the cause of death?

When a character who has low hit points from a fight dies after losing constitution from a disease, how do you tell which is responsible of death?

Example: Lets take a character who has ghoul fever. The said character normally has a constitution of 12, and has a maximum of 9 hit points. He gets into a heavy fight which drops him to 1hp/9. Afterwards, his con. score falls from 12 to 9, because of the ghoul fever. His hit points are now at -1/7, and he subsequently dies (correct me if I'm wrong).

Was the cause of death ghoul fever, meaning that he rises later as ghoul, or is it the wounds he got during the fight, meaning he doesn't?

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Minor point: Characters don't die of hit point loss until they hit -10 hp in 3.5e. Your example would require the character to have -9 or -8 hp before taking the constitution damage, and -11 or -10 afterward. – GMJoe Jul 7 '14 at 3:40
@GMJoe Once the creature's at -1 hp it's dying, so I assumed the creature subsequently died 9 rounds later because it didn't stabilize, although the question is unclear on that. – Hey I Can Chan Jul 7 '14 at 14:26

A creature who, because of ability damage from a disease, reaches Constitution 0 is killed by the disease. If a creature has -10 hp before that happens, the creature has, instead, died from having -10 hp (usually via injury).

In your example, the wounds from battle killed him, not the ghoul fever.

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I don't think this is the intent as it would mean most peasants (with 1-4 hitpoints) can't turn into Ghouls. – C. Ross Jul 6 '14 at 20:01
Correct me if I'm misremembering, but I thought a negative Con modifier couldn't drop your max HP below 1/HD. If I'm remembering that right, it's relevant to the 1-4 HP peasant case, in that (uninjured) they'd stay at 1 of 1 HP regardless of Con penalty size, until Con itself hits zero. – SevenSidedDie Jul 6 '14 at 20:53
Regarding your edit, Con changes are always retroactive—that is, hp is recalculated as if the new Con modifier had been the case when the HD were rolled. So given that text confirming my memory, plus that principle, I believe the opposite conclusion is true. – SevenSidedDie Jul 6 '14 at 22:04
@SevenSidedDie Upon further reflection, I believe you're correct. Really, though, I'd like you to look at it on PH 6 so you'll understand my brief confusion--the first quotation is bulleted while the second is after all the bullets, implying an exception to the bullets. But now I agree with you. It'd be too weird otherwise. (The text would be weird, that is... not that agreeing with you would be weird.) – Hey I Can Chan Jul 6 '14 at 22:09
Just from the part you quoted I could tell it was weird, no worries. I was about to agree until I remembered our questions about shapechanging Druids' Con-derived hit points, which made me double-take. – SevenSidedDie Jul 7 '14 at 0:21

## From A Roleplaying Perspective

Ghoul Fever turning people into ghouls after they are dead is an obvious tie-in to the 'zombie' horror movie genre. It makes more sense that anyone infected with ghoul fever who dies, unless the body is destroyed in that death, is raised as a ghoul.

It would even make perfect sense that a Cleric could cast Remove Disease on a corpse infected with ghoul fever, and prevent the ghoul from rising, although the corpse is an illegal target by RAW.

If you wanted to portray the disease as something which chains the soul, and a quick death is an escape from that process, that provides a vehicle for the existing RAW to be explained.

But the general expectation of 'zombie-like' illnesses is that any death triggers the 'undeadening' into a zombie. Working with this trope rather than against it will generally be appreciated by players who are fans of zombie horror movies.

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