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I teach kids and they play pretty much everything they can get their hands on. Parents buy them games and either don't know the ratings exist, don't care, or (don't) buy games based on what they've heard from media or other parents. Some kids don't play 18+ games like DOOM or Resident Evil because they saw trailers or saw streamers play them and they decided for themselves it's too gory/scary.
I don't think an age rating is useful either, I think it's way more useful to tell people what potentially sensitive content a game (or movie or whatever) has and let them (or the parents) decide for themselves. For some parents, nudity is where they draw the line, for others, it's scary imagery, others still can't abide drugs etc.
It has always been up to the parents. They are guidance for parents to have an idea of what questionable stuff might be in the game, not the law.
Grotesque violence that nobody is going to relate to.
I wouldn't have been moved by it at 6 years old, not even a little bit.
There are plenty of stuff, non explicit, without a trace of gore that are infinitely more disturbing.
PEGI is a voluntary parental guidance / recommendation system that is not legally binding.
That said, nobody is buying Doom under the impression it's anything other than a hyper violent shooter, just like nobody is buying Mortal Kombat games expecting a kiddie friendly Street Fighter clone.