I may have previously mentioned that I run games for beginners at my school's D&D Club.
The reason I endlessly bring it up, is because playing D&D with students constantly forces me to reckon, in a professional capacity, with many aspects of the game that...eh, I didn't think too hard about when playing with my friends. Certainly not when I was a teenager myself, but even as an adult. Like, I was aware of the issues Snarff raises, and found them abstractly interesting, but I didn't sweat them.
But now I don't have that luxury. I am governed by the School Act of British Columbia, which includes a raft of ethical obligations with professional and potentially legal consequences attached. I can get fired for getting it wrong. So I have to think long and hard about what will be included in games I run at school, just as I do about the content I will teach or whether it's a good idea to bootleg for a student who saw me going into a liquor store (this actually happened; he thought it would be really cool of me).
So, violence in D&D. Sexy stuff can happen in D&D, but that is easy to handle: in my school games, it basically doesn't exist. I tell my students "PG rating" and they have no trouble understanding that this means. No bewbs.
But, as Snarff points out, we have a HIGH tolerance for violence in entertainment. Particularly in North America (incidentally, we just got back from Europe and they think we are really weird about this. People go topless at the drop of a, well, top, and don't sweat sexy content much at all.*** But they regulate violent content much more strictly than we do, especially for children. I am pretty sure that they have it right).
So we have to set out what that PG rating means in the context of violence as depicted in a Victoria, BC High School D&D game where students are roleplaying violent people. What we've settled on is that killing people in the context of the game is okay, but the descriptions can't be too gory, and we're not roleplaying sadistic violence. This is kinda lame, TBH. When my kid played in home games in his earlier teens, he delighted in describing finishing blows in the most cartoonishly exaggerated ways imaginable, and it was hilarious. But, yeah, school. We can't do that.
So, professionally, I have ruled that solving conflict through murderous violence is totally acceptable in the context of a D&D game, as long as you don't get too visual, and everyone seems pretty cool with it. No complaints. And believe you me, if you screw up and parents hear about it, you get complaints.
However, we don't use alignment as part of the game. And that is partially because I want students to at least have to consider whether any particular act of violence is justified.**** And this very much does change how the game is played. When a group of orcs might include some children and furthermore have a pretty good reason to have turned to raiding because they have been pushed to the margins of an expanding nation state, then just killing the orcs to get the treasure is problematic. Our last campaign wound up with the party allying with a group of pirates that they were initially hired to hunt, and then helping them take down a much more wicked group of pirates.
TLDR: Violence in entertainment is pretty universal, and I don't think it's automatically a problem. I mean, I'm a lifelong pro wrestling fan. People can distinguish between reality and fiction. But there have to be lines, and those lines depend on context. I do think getting rid of alignment makes decisions about violence a lot more interesting.
***Like, we were at Tivoli Gardens in Copenhagen, which is the theme park that Disney copied and supersized, and there is a poster of a cartoon topless woman enticing you to go to a bar right next to the play area for tots. I could post a photo, but forum rules. Note that if it was a poster of a cartoon decapitated body, I'm pretty sure I could post it. See, we are weird about these things.
****But mostly because I think the alignment system is strange and weird and does nothing for the story in general.