Spoilers again! Sorry, this one is long.
Lewis' room is a colourful mess, filled to the brim with distractions and drug paraphernalia. A core aspect to his arc is the correspondence between his psychologist and his family, as well as the seemingly motherly relationship Edie has with him. Through letters/narration/environmental storytelling we get a pretty clear picture that Edie has instilled some risky ideas into a person very susceptible to escapism. In the moments prior to his death at his dead end job (puns), we get to see the climax of his declining mental state as he slowly succumbs fully to escapism, seeking out a colourful world of adventure in his head and losing sight of reality, causing a sort of workplace suicide.
If the dev team wanted, they absolutely could have simply focused on the realism perceived by a bystander. We watch a dude at a fish company get decapitated by a machine, people scream, his family cries a lot, etc. Or, instead, we could get a first person perspective of his thought process in his final moments, which has a hell of a lot more to say about his entire life up until that point than watching him get killed. If you remove all of the light-at-the-end-of-the-tunnel insight from the game and promote visual realism, it just becomes a depravity circus.
Death is often ugly for bystanders, for sure, but the game doesn't seem at all interested in making death itself ugly (though I'd argue it unintentionally does by implication). It wants to show how ideology and narcissism can cause undue suffering, and how that suffering can manifest in the minds of gaslit individuals. The game doesn't showcase the "vile" or the "vicious" through the act of death itself, rather through Edie's response to said deaths, and how she propagates a death culture within her own family. I'm not a particularly sensitive person when it comes to emotional forms of media, and I didn't react emotionally to this game. Some people obviously have and will. I can quite confidently say, however, that Edie is a vile antagonist. I don't need to be emotionally sensitive to say that; we have societal conventions in place that prevent ideas like glorifying the deaths of your family members for personal gain or overburdening frail individuals with potentially life destroying ideology from being considered acceptable attitudes.
If a non-"softball" approach to you means watching the 10 year old spasm on the floor while she froths at the mouth, fair enough. While that's certainly immediately shocking, I fail to see how it is of all that much use narratively in giving players a unique insight into the psyche of a starving girl who's just eaten an entire tube of toothpaste and poisonous holly berries as she succumbs to her ailments. You don't learn anything about a bloodline of adrenaline junkies; about the brilliance of the Finch family creatively; about how an unrestricted adventurous spirit can be catastrophic. You simply learn that her parents might be neglectful, and any assumptions about her own character are purely theory (or dictated via stone-faced exposition which isn't my cup of tea).
I'm not sure what you think the tone of the game is, but the game is centred around a conflict between Dawn and Edie over who bares responsibility for the countless deaths in Dawn's immediate family (emotional consequences, so to speak). If facing the mental states of the deceased in their final moments head on in the first person isn't tonally consistent, I'm really not sure what is.
Death indeed is an ugly thing, but I find when I think of friends of mine who have committed suicide, I'm seldom honing in on the act itself and more focusing on what might have led them to that point. Anecdotal, but I find it relevant.
Couldn't really think of a succinct way to word this, apologies lmao