Endings shouldn't be neither rewards nor punishments. Just consistent consequences
exactly. The 6 months to live problem is not a consistent consequence.
If you didn't help Panam with her Problems, she won't help you in your time of need. That's a consistent consequence. By asking the Nomads for help, some of them die. Same thing.
If you don't ask the Nomads for help, they will leave Night City without you. Logical consequence.
If you romanced Judy, she won't stay with you in Night City, because she has seen what the City has done to Evelyn. Lovigal consequence.
Presenting rewritten DNA as a problem is nonsense. What is it a consequence of?
It's also an issue of roleplaying. If I play V as a Nomad, who came to Night City in search of a new family, and found that with Panam, there is no reason to consider helping Arasaka.
If I play V as a Street Kid who admires Saburo Arasaka, becoming the new bodyguard to Hanako or Saburo would be a huge honor.