I think games where killing is kept to a minimum should do this. Would make each death seem significant.
I am kinda getting tired of suspending my disbelief at a regular old character in everyday clothing mowing down hundreds of enemies throughout the game. Just got done with Tomb Raider where she went from crying from her first kill to murdering an entire island of people.
Perhaps violence would be more respected if the violence applied to *you* the main character had more impact. Part of the problem with mowing down hordes of stupid AI enemies (which don't act very "human" like anyway) is that most of the time when you take damage there are no realistic consequences to either side's actions. Instead of waves of idiot nameless "bad guys" rushing your position perhaps it would be more interesting and believable if their AI routines reacted to the violence? What if they acted more like individuals rather than robots?
That could itself be used as a mechanism to show the player that they are bad people (if that is the intent) such as:
-Having a group of "bad guys" start seeking cover, meanwhile yelling that they're going to kill you because you've killed so many of their pals.
-Some of them will yell out that this isn't worth it and the main character will simply kill them, and they have families, and they don't want to die.
-When you shoot someone (but they aren't dead) you hear them screaming and crying for their mothers and for help and yelling things like "I can't feel my legs!" or "It hurts! Make the pain stop!". They plead with their friends to help them and ask if they will be okay, and their nearby friends try to provide emergency medical help and to reassure them.
-After a few of them are killed by you then maybe someone starts screaming "I don't want to die! Let's leave this asshole alone - it's not worth it!" and starts crying at the destruction. Some actually leave.
-One of them just loses it, and with sobs in their voice, they rush the player yelling stuff like "You killed everyone I know. I'm going to kill you, you bastard!!!" while they would have tears streaming from their eyes (if they could be rendered). This one crazy person then stands up and runs straight at the player.
Another aspect that is silly in most games where the violence is supposed to be a bit more believable is that the main character sure can handle damage well. Get shot in the back where a normal human would be paralyzed for the rest of their life? No worries - you will still be able to run around like normal and either wait a few seconds or eat some magic healing rations to remove all traces of the damage including the scar tissue. Maybe in a more "realistic" game if you get shot in the leg (and if it doesn't kill you from bleeding out) maybe your character is slowed down with a limp for the rest of the game. Why does the main character always get away with no lasting damage?
The impact of violence is not really the gore - it is the death, dismemberment, misery and tragedy resulting from its outcome which the vast majority of games may only reveal a very small aspect of. Most games completely gloss over these results (as well they probably should).
Obviously I am talking about this in terms of games where the act of violence is supposed to have an emotional impact to the player, so I am not talking about all games that use violence - especially those that use violence in an overly cartoony or even comical way. Also, this applies obviously to games where the designer *wants* to make an attempt in portraying this type of emotion. Since almost every game I've played has such unrealistic violence anyway, this seems to be a pretty silly statement for a major video game designer to be making and like I said the impact from violence is really not from the gore anyway.
Probably the games with the most "realistic" violence in it I have played is SWAT3 and SWAT4 by the way. It captures the deadliness, horror, chaos, confusion, and noise about as well I could imagine, all without going over the top with gore mostly because a lot of gore in video games are pretty unrealistic and over the top anyway - heads and body parts don't "explode" nearly that much in real life when hit by a bullet to the best of my knowledge. Lots of blood though but not fountains as in some games.