If players desire an extra threat of danger, they can decide to play Gloomhaven with permanent death. Any character will permanently die when they drop below one hit point (instead of being exhausted). Characters can still become exhausted as normal if they are unable to rest or play cards, except that their figure remains on the map and can still be targeted by monster attacks. The character cannot act at all and is considered to have an initiative of 99 for the purposes of monster focus. After a scenario is failed, any character who is still alive at the end of the round survives and can continue playing.

When a character dies, all the materials for the character are returned to the box, any items the character owned are returned to the city’s available supply, all money the character owned is gone, their personal quest is shuffled back into the personal quest deck, and their character sheet is removed from the game. The player whose character died must then create a new character to continue playing.