As a ref, I was pretty merciful. Most of my players put a lot of thought and effort into creating and playing their PCs, and I felt considerable guilt at just the thought of killing any of their characters off.
That said, without at least a chance of perma-death, a game's stakes are lowered and a lot of suspense is lost. So, my unofficial policy basically became, "three strikes and you're out". The first two potentially fatal rolls were either downgraded or hand-waved away. However, in a bit of a Catch 22, I felt a guilty fudging rolls.
In the future, I think I will use a house rule like D&D 5e's Inspiration mechanic, or Karma points or something like that that a player could use to negate a PC-killing roll. Someone created a "Bravo Zulu" optional rule for 4e that essentially works like that. I have the one-page PDF of it and, IIRC, it was a fan-made, free-to-share type deal, but I'm not 100% sure on that so I don't feel comfortable posting it here.
In my solo 4e campaign, I decided not to fudge rolls at all. It really did heighten the anxiety and suspense of combat scenes. It also made it immensely satisfying when my party medic successfully treated a critical mortal wound preventing another PC from dying.
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