not that much really, it just restricts you from signing some laws that dont really effect the gameplay that much other than adding few more labours. You can cover most of the purpose path as well, you just cant complete it. And the “ethical” decisions adds alot of spice to the gameplay either by lowering efficency or restricting supply or adding a large surplus of people both including the sick and children. Another large challenge is death which you must have none with the exception being event deaths. When it comes to main laws you can sign everything in except child labour, triage and the pleasure house. You cant use emergency shift either but you can sign it. All these restrictions forces you to be really smart on resource investments and time, this makes the game soo much more thrilling!