Still doesn't matter. It's a game, i.e. not real. People will either live with it or not buy it. Simple as that. It's the truth and if you don't like it then that's pretty much your problem.
It is a game, where people shouldn't have to worry about their phobias and should have fun. Just because it's "not real" clearly doesn't make a difference because tons of people with arachnophobia say that it still applies to video game spiders. It's a
phobia. It takes some people months to overcome it and it's never easy. It's not always as simple as just "live with it." How would you feel if you had a phobia that prevented you from playing a bunch of video games, especially ones in a series that you love? I know for me, it would be a huge bummer.
I'm not saying Bethesda HAS to add it, but it wouldn't be the first video game to include a "no spiders" option, and since we've seen 4-5 or more spider threads in just a couple of months, I'd say that represents a big demographic where that's a make-or-break issue.