Off handedly talking to my friends yesterday I realized Karlach was the single thing that decided between Good/Evil Urge for me.
In act 2 you can not kill Isobel at Last Light without killing Dammon with the Shadow Curse, in hopes that he could fix Karlach I couldn't bring myself to do it.
But now that I'm about to finish my playthrough and see there's no hope for her. Next time there will be no mercy. Butcher and Burn everything.