What does "survive in hostile enviroment" mean when death is not permament? Nobody is afraid of death in game itself - they are only afraid of losing their equipment. On longer run this game have no goal. Only players find their own and try to reach them.
Anyway if you crippled limb is supposed to be penantly for death it isn't really something to be afraid of only to get irritaited by and that's what I want to point out.
For your information, I would welcome permanent death. But I can see how it might impede actual beta-testing and won't be implemented any time soon, so there's no point in advocating for it now. Maybe someday.
The question if one is either "afraid" of dying or losing items is just semantic. We mean the same thing. Dying is a setback. Setback is what people don't like. If they don't like it, they have an incentive to avoid it. If they try to avoid dying, the in-game world gains more credibility and therefore allows more profound, enjoyable experience.
Crippled limbs can in no way be a penalty for death. You get them crippled before or while you die and they just stay that way. If you don't die you have to heal them yourself or find someone to do it. Death is a death. Even if it's make-believe it should in no way help you with ANYTHING. You were injured - you are injured, you were poisoned - you are poisoned, you were radiated - you are radiated, you were addicted - you are addicted, you were tagged for some crime - you are tagged for some crime. That's how it should work. If there are any benefits from dying, death will be exploited -- resulting in bullshit. The only penalty for dying is losing items (which are way too easy to obtain) and being stranded without them with exactly the same problems you had before dying. It's the setback that will require you to put some effort to regain your previous status.
An example of bullshit mechanics:
I was once exploring caves near the Glow. It's quite far so I managed to use almost all ammo, not realizing I had just about dozen shots left. And then I got my leg crippled. Tough situation: I can't run from encounters and I have ammo left for just one fight at best. And there are ghoul crazies on the way. My first attemp at doctor skill failed, but the countdown was only 12 minutes back then so I thought, I'd give it a try and took a short brake. With a freak luck the second time was a success.
But I could as well go to the Glow drop my items in an obscure corner, wait to die, respawn healthy as a horse, run back (on the way picking up some more ammo from my tent), and easily escaping any encounters be back at the Glow, quickly get my stuff back, get out and continue to rock and roll. All in a matter of maybe 3 minutes. If a game allows something like that, it means its mechanics are broken. Of course one broken leg wouldn't make that much difference. But it would stall me for several minutes, maybe more if I were to die three times in a row when trying to leave the respawn point. If getting there back was to take me 20 minutes, maybe I'd reconsider and just risk travelling injured. That's why these small obstacles like permanent injuries, poison, radiation, weakened state have a purpose and aren't just a pointless nuisance.