With all the horrible ways to die presented in Tomb Raider, why are the impalings singled out as gratuitous or exploitative? I think that it has less to do with their content and more to do with their context.
I have found myself struck with admiration recently by games that I have played that have put me in less than empowering positions, games that celebrate difficulty and hardship, struggling and deprivation, rather than empowerment and excess.
Amid a hail of gunfire, the player-character crumples to the ground, defeated, that is, before a loading screen pops to revive her. At least, that's how most action games represent death. In Tomb Raider, I've seen Lara Croft stabbed through the neck, had her head split open on a coral reef, seen her torn apart by wolves.
Home is where we see characters in a state of normalcy. We get to know what the protagonist does between adventures, and for a medium that depends so much on empathizing with the lead character, seeing who they are at home, away from it all, is a significant experience that more developers should consider investigating.