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I haven't finished it, but I'd say Vampyr makes you make some difficult choices
2077 cyberpunk only plays out badly
The saddest ending is the one where you win.
technically on par for a dystopian game
Detroit: Become Human fits the bill perfectly! It's a great game with some of the hardest choices you'll ever make in a game period.
Depends on the kind of games you enjoy.
While not particularly about consequences of decisions, I highly recommend Frostpunk. It always feels like any decision is about trying to choose the less horrible one, but without ever knowing if it will work out or not. The atmosphere of that game is just superb.
I’m not sure I’ve seen it posted here, a little older, but the TellTale Walking Dead games are killer. You make full choices that affect your game later. Tons of fun, not a ton of action gameplay but the stories told are next level IMO
Just answer our increasingly difficult questions.
Trolley problem: One track is one person, the other is 10
Next level
Okay well now the one person is your mom, and the 10 are 1 year olds you don't know
Next level
Okay the one person is your best friends mom and the 10 are young kids from your immediate or extended family
Next level
Okay the one person would cure cancer tomorrow, and the 10 are friends or family
...
The trolley problem is easy all of these questions are easy
"Passage" is a very short one. But the choices matter.
i'm gonna blatantly disregard your "but where the consequences actually matter" and recommend most of telltale's games (The Walking Dead and The Wolf Among Us are the better ones).
besides them and the suggestion of others i would also recommend Tyranny. great CRPG made by Obsidian.