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I get what you mean! I think this is exactly why it would be great as an expansion pack, not a base game update. It would be a great expansion pack for those (like me) who desire more realism and depth for the game. Those who do not like these topics to be introduced into the games can keep playing with the catoonist version that you prefer!
I can even imagine that a good compromise would be to use made-up diseases but using realisitic dynamics. I care less about it saying "your sim has coronary heart disease" than the gameplay experience of needing to take care of the sims and making sure they have a healthy lifestyle, and avoid accidents. These are also not completely new concepts, drowing or burning to death are already accidents but there is simply so much more potential (including non lethal accidents). Same goes for diseases, they already introduced a form of rabies that can kill you if bitten by a hamster, but that is so niche and its strange to have one single rare disease in the game, apart from which the health of your sim does not matter.
I hope it is clear what I mean!
I completely get what you mean, i totally forgot about first pet stuff pack which also have 1 death type oops😅😅
Diseases should definitely be in the packs rather than in basegame update so i completely agree with you here
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