I did not defend generic settlers being immortal in Fallout. For one I think it does not make any sense, especially since player IS mortal.
In case of companions however I can see justification. With current state of the AI, mortal companions just turn combat in to babysitting horror resulting in to either a. player no enjoying combat to it's full potential or b. not bringing companions in to combat at all. Which turns whole idea of companionship upside down. Companions should help you in combat not make it more difficult. My own experience from NV hardcoe mode.
What I really miss and what would be easy to implement is AI which flee when low on health, flee when enemy level/difficulty is too high and AI which would switch to different tactic when facing ranged and melee enemy. It does not make sense for AI to seek cover when facing charging mutated bear. It just get's NPC killed. Switching between weapons according to distance and type of the enemy would be also nice.
And last, there should be some customization available for player to be done on companion AI. Other games did that successfully (Dragon Age origins is notable one).
AIl Bethesda games suffers from mediocre at best AI. In such case I can live with immortal companions.
That said, I can see some improvement in F4 AI over F3/NV one. I especially enjoy Dogmeat AI and I can see that lot of work went in to that character in general. He is my favorite companion by far. I enjoy using him tactically, sending him ahead to inspect suspicious locations or corpses and then snipe enemies from afar which he provoke. What I miss thou is easier command interface. I would really like to have shortcut which would select companion without need to point and click at him.
That said, I would probably not use Dogmeat in combat if he would be mortal. Despite all, his AI is simply not good enough.