You can save scum and she’ll be back, but one of the characters highlights it:

Clever. Verrrryyy clever. You think you’re really smart, don’t you? In this world, it’s kill or be killed. So you were able to play by your own rules. You spared the life of a single person. Hee hee hee…

But don’t act so cocky. I know what you did. You murdered her. And then you went back, because you regretted it. Ha ha ha ha…

And the whole game is full of situations like this. Highlighting that your actions actually have some impact, even if you can reload or start a new game.