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Orcus's "Voice" lair action is casting the spell Power Word Kill. If he were to use it on a PC, would they drop to death saving throws or instantly die?

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Spells do exactly what they say, whether cast on PCs or other monsters.

Power Word Kill says a creature with 100 hit points or fewer dies. PCs are not exempt from this as they are also creatures and thus are perfectly valid targets for the spell. Do not pass go, do not collect $200, do not make a saving throw vs the effect, do not drop to 0 HP and start making death saving throws. They just die like any other creature targeted by the spell.

Note that this is a 9th level spell so it's meant to be powerful.

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At this same time, we nearly always say that bad guys die once they reach 0 hp, even though they are allowed the death saving throws too... – Alexis Wilke 1 hour ago
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@AlexisWilke Allowed, yes, but to be clear the 'default' is not that according to the Monsters and Death/Knocking a Creature Out sections on PHB p.198. NPCs that make death saves rather than dying at 0 are the exception, not the rule. – CTWind 46 mins ago

They would instantly die, with no saving throws. However, at this level, players are assumed to have access to means of resurrection, so this isn't as devastating as it would be at earlier levels.

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Power Word Kill does kill a PC with fewer than 100 hit points without a save. However, a quick calculation shows that there would be many high level PCs that would have more than 100 hit points at full health (a level 18 paladin with CON 10 would have an average of 99 hit points, for example).

Additionally, this spell is actually a bit on the weak side for a 9th level spell. If a monster cast Meteor Swarm on a party of PCs, they could potentially take 40d6 damage each, which would add up to far more than the 100 HP maximum damage that Power Word Kill would inflict.

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On your comparison, it's worth noting that Power Word: Kill doesn't actually inflict 100 damage. That's an important distinction: PWK doesn't do a lot of damage--which might be mitigated by resistances (rage, anyone?), buffs, reduction, temp HP, wild shape HP, resilience, &c. &c. &c. It just kills you dead, no death saves, straight to the grave you go. Your meteor swarm does an average of 140 hp damage, which is big, but PCs are generally build around surviving taking damage. Being suddenly dead (completely dead, not just mostly dead), not so much. – nitsua60 3 hours ago
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@nitsua60 It's true that dying is different from HP loss. I'm making the comparison simply to show that it is not exceedingly out of line for a 9th level spell. – Icyfire 3 hours ago
    
I guess it's the phrase "the 100 HP maximum damage that Power Word Kill would inflict" in your last line that undermines the comparison for me. I think it's a fair comparison and it seems like you start out recognizing that they're qualitatively-different effects, but then I worry about the second paragraph confusing future readers. – nitsua60 2 hours ago
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It should also be noted that because you have max HP at level 1, the average health for a level 18 paladin actually becomes 103.5 rounding down to 103. Now if you just take the average HP every level, 6, with the max at level 1, 10, the number is 112. – Levi 2 hours ago

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