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Here's something I've been confused about. The description for Ettin in the MM states, "The twin heads of an ettin are two individuals trapped in the same brutish body. Each head has its own mind, personality, and name, and possesses unique preferences and quirks."

By that logic, if one head dies (chopped off, disintegrated, etc), does the other head continue to live and control the body/ fight? I mean yeah there'd be a hell of a lot of blood and it probably wouldn't live much longer than a couple more turns, but would it technically still be alive? I mean it still has a functioning brain...

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D&D doesn't operate by hit location, so I think the answer is more abstract than that. An ettin has a defined number of hit points. Both heads share the same body, circulatory and respiratory and ambulatory systems. So I'd be inclined to say that both heads operate until the monster goes to 0hp, then they both stop.

If you wanted to make a homebrew that is more entertaining about that, then you could work up a separate head hp setup, maybe partly modeled on the hydra, and the characters have to kill them both. Maybe when one head dies, the other loses partial control of the body, kind of like it had a stroke, and bleeds, and so on.

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If this is about the Vorpal weapon, its description says "When you Attack a creature that has at least one head with this weapon and roll a 20 on the Attack roll, you cut off one of the creature's heads. The creature dies if it can't survive without the lost head". The DM decides whether an Ettin can survive without the lost head (much like with a Sword of Sharpness: "you lop off one of the target’s limbs, with the effect of such loss determined by the GM").

If you are curious about canon from previous editions, Ed Greenwood's "Duh 'Cology of Duh Ettin" article (Dragon #92, 1984) indicated that "an ettin who survives the loss of one head is able to continue a normal life with just one, but other ettins view it as deformed".

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