Take the gameplay engine of Max Payne, but remove the "bullet time" feature, and replace it with the ability to transform into a giant monster with a blade for an arm for short periods of time. Then move the whole setting to the rusty, bloody Otherworld of Silent Hill (particularly the prison bit of Silent Hill 2), maybe season with a little dash of the first Half-Life, and you've got The Suffering. The Suffering is not the most original game; nearly every element, both aesthetic and gameplay, can be traced to some other big-name title that came before. However, it is noteworthy in being able to take a somewhat dated and janky engine and actually turn it into an effective horror experience that also has fairly satisfying gameplay.
We play as Torque Somethingorother, new resident of the Abbott Prison island somewhere off of Maryland, and apparent muscly older brother or cousin of GTA 3 Guy. Torque is prone to blackouts; apparently he killed his family during one, though he doesn't remember anything, and that's what has led him here. While chillin' in the cell one day, however, the power goes out, and otherworldly monsters start attacking everyone. The goal is to fight your way out, whilst also enduring Max Payne-like trippy flashbacks and visions. I guess the game is technically "survival horror", but ammo is very generous, and there's heaps of monsters thrown at you that you have no choice but to kill your way past, so it's really more of an action-FPS in a horror environment, with only the most minor little puzzles every once in a while.
The game also does have something of a morality system. It's the fairly simple standard "black and white" thing; you'll encounter guards and inmates trapped or about to be killed horribly, and choosing to either help them or off them can raise or lower a karma meter. This effects the ending you get, but it also effects gameplay; the current location of the karma meter determines what type of a monstrous beastie you transform into when you use the temporary "insanity" power. The "evil" beastie is actually the most powerful, almost making this an actual implementation of a meaningful moral choice system; the "good" beasties are also so overpowered, however, that it really ends up kind of meaningless which one you go with.
Much more of the game's time is spent in shooting and hacking the reams of enemies with more conventional weapons; this is where the game falls apart a bit in terms of level design. The one major shortcoming of the game is that it suffers from the unfortunate Xtreeeeme Attitude in level design philosophy; the designers just don't have a good sense for when enough is enough, and instead of careful suspenseful pacing, it's just balls-to-the-wall constant battles against way too many enemies who take way too many shots to put down, and just keep charging you in the standard Bullet Sponge On PCP style. Often you run into these big areas full of endlessly respawning enemies that I guess the game intends for you to just try and run through, but there's never any indication that it's a part where you're NOT supposed to be fighting, so you can end up wasting heaps of ammo before you figure it out. And with the automatic save-over checkpoint system, unless you're manually making tons of different saves, potentially just one of these situations could force you into having to start over. You also end up fighting human enemies, and they do the same "bullet sponge" shit that the monsters do; take tons of shots to the head and torso without so much as flinching, and just keep suicidally charging you to whittle your health down. There's one really shitty moment where you fight the prison's warden in a boss encounter, with a posse of his men; he takes forever to bring down, then as soon as you do, the room gets flooded with like 800 monsters out of nowhere. It's not the best plotted-out game ever.
Setting aside those Mt. Dew-fueled miscues, however, it's really a pretty good game. The monster designs are great, the creepy atmosphere is impressive given the limited engine they're using, and the gameplay is very solid.