Pedantic
Legend
No, definitely not. I'm, I think, significantly more sympathetic (perhaps even empathetic) to your feelings and viewpoint than anyone else here. I think we're running up against language concerns, where I'm suggesting that "realism" is not necessary/the underlying goal in creating the kind of independent, immersive setting you're talking about. I'm talking about what realism (in the sense of creating a mechanic that portrays a real world process or event) does and why, and where it fits in mechanically.Are you seriously taking the stance that realism is objectively not desirable to anyone? I can't begin to explain how wrong you about that. There is no advantage to telling people they are wrong about their wants and feelings.
You've said yourself a few times that you accept hit points as an abstraction, right? That's prioritizing another goal over realism, one of the two cases I called out, and the other is eliding realism altogether and mapping a different norm for how injury works that reifies hit points in setting. What is the reason someone might prefer to use a "realistic" depiction of injury, say something like vitality/wound points instead of those two options, or an injury table or whatever instead of doing those first two things?
I'm positing that it's easier and naturally more complete. It requires less mental load to imagine a world that deviated from reality and/or less precise mechanical modeling (or projection from mechanics to setting) to figure out what happens when someone gets hurt, and what the larger role in the setting of injury is.