With V.A.T.S. the PVP combat would almost certainly have to be turn based and very boring in my opinion.
Without V.A.T.S. the game almost wouldn't feel right and probably not be fun to play.
If they reconfigured VATS for online play and came up with a solution to how you could still use VATS against other PC's but not pause the gameplay, that would be very interesting and I can almost imagine sniping someone from a distance and instead of seeing them freeze when I entered VATS, they would still be moving and the percentages would fluctuate based on certain factors.
I was joking about the last poll choice, but I am anxious to see who really votes for that one. Most likely Fooism, b/c he doesn't know where babies come from. LOL
Edited the choice to ban me to the choice of not wanting a fallout MMO