The key point for options is that Larian would provide 3-5 default sets of options that they've (roughly) balanced the game for: story, normal, hard, 5e core, tactician. Then, each of those difficulties has a full suite (1-3 pages) of settings: toggles, sliders, etc. Most people can just click one of the difficulty settings and be on their way (or change 1-2 settings: e.g., unlimited resting box "on").

Games are strictly improved by adding options, as long as the developer still provides a sufficient spread of default options. Otherwise, the player has to decide everything for themself which I agree is some combination of tedious, stressful, overwhelming, and not our responsibility.

Obviously some things are not worth the effort of implementing (e.g., RtwP) as options. But small things that Larian probably experimented with anyway or would already change for different difficulties (# of short rests, spell surfaces, anyone can use scrolls, high ground advantage, natural 20s auto succeed on skill checks, perma-death) should be very small effort to include as options. These types of things also would have a small chance of creating bugs, due to their simplicity and/or having already been tested in EA.