Personally, I'm more of a gray morality dude, so I wouldn't just pick the LS/DS choice all the time, I'd pick what feels right, but I'm wondering if this is a bad approach.
Do my choices matter? If I let person X live (or not), do they come back to haunt/help me later, making new quest lines or changing them in some way?
Are class quests alignment-affected? Am I losing out on content if I play mostly neutral?