Originally Posted by Santos 
"usually when players turn on perma death all it does is force them to reload when someone dies."
I must be getting old, because this seems, to me, how video games should work.
Then it's mainly just an annoyance. I'd prefer it either like in FO3/FO:NV where the companion(s) will be knocked out, or i'd prefer true perma death (like in a Rouge-like game), then there will be a true sense of loss, something that you will never have otherwise.