Well, yeah, I agree, it's the wasteland, and it's harsh, and bla bla bla.
The point everyone's trying to make is if, say, you're playing fallout, and you kill someone at NCR and now you're wanted there and everyone wants to kill you, you don't just die and run back and then everything's honkey dorey again.
If you burst kill someone at NCR, the consequences shouldn't be "death, respawn, run back to town like nothing happened."
Your actions should last well after death.
Edit:
I'd also like to add that if you're going for the realism over fun aspect and saying, "The wastes are harsh, get over it." I seriously doubt if we were actually living in the wastes, there would be naked people running in to towns using a sub-machine gun on the first guy they see. And I'm sure there wouldn't be near as many (if any) suicide bombers.
There's this thing people in real life have that they don't have in the game that stops people from doing stuff like that, and it's called self-preservation.
In a real life wasteland scenario, yes, it'll be rough- There will be raiders and gangs and what have you, but the actiongs in question in this thread just wouldn't happen in the wastes.