I think you'd need to decide whether the game is the equivalent of art, or if it's a product designed to reach as many people as possible. That's the one thing I really disagree with GMTK about; not having a ton of accessibility features doesn't necessarily mean the developer doesn't care about disabled people, it could just be that the game wants to elicit a specific emotion that doesn't translate well if the game is made more accessible. He said in one of his videos that Doom Eternal being difficult makes it innaccessible to people who aren't good at video games or have other disabilities, and implied that it isn't fair that people with accessibility issues don't get to experience the same power fantasy that everyone else does.

For example, FromSoft games (Dark Souls, Sekiro, etc.) don't have difficulty options because the developers want you to struggle and feel triumphant when you eventually succeed. People have complained for a long time about how the game is inaccessible, but FromSoft hasn't budged because that feeling of mastering the combat and beating overwhelming odds is the point of the game. If they had an easy mode where you could just run through without a care in the world, it would just be another crappy open world game.