I'm sure some people may worry about that possibility. Personally, I don't think there is any danger of that happening.
I wouldn't know about blowing away the guys begging for water. I play as a good guy. My karma is off the charts. Actually, the dismembered bodies on chains and such do bother me but I can kind of ignore those. It's the exploding heads and animated decapitations center-screen that are hard to ignore. I'll cop to being a middle-aged wuss.
By the way, I killed a Super Mutant brute with a b-b gun. Anybody else ever do that? It took forever and it was hard avoiding his minigun. When I finally ran out of ammo, the brute and I were both about dead. I ran around behind him and finished him off with a lucky shot from a basebal bat. My son and daughter cheered. Ah, family bonding.