The premise revolves around sadistic choices, survival, and human desperation under extreme pressure, with no race- or gender-swapping of established characters and no prominent LGBTQ+ representation or identity-focused arcs. Casting includes incidental diversity among original characters, such as Lawrence Gilliard Jr. as Dr. Barden and Enver Gjokaj as Lucas, but this remains organic to the ensemble of desperate contestants rather than a deliberate statement.

Themes touch on class disparity and the wealthy exploiting the poor, as noted in some reviews framing it as a parable of haves versus have-nots or critiques of the healthcare system, yet these function as classic horror backdrops for the game's moral dilemmas and are not activist messaging or the foundational driver. Director David Guy Levy and cast interviews emphasize psychological tension, the game concept, and influences like The Shining or Clue, with no statements on inclusion mandates or social justice intent. Reception shows no notable woke-related backlash or praise for progressive elements, aligning with traditional entertainment-focused horror.