Earlier quoted context omitted.
> I don’t want websites to be able to send notifications to my phone. You might not, but our users requested desktop and mobile notifications. The notifications let sick patients know when their prescriptions are ready, facilitate care-provider check ups, etc.
PWA cab be 'installed' to the device, similarly to 'Add to home screen' option. It would be reasonable to allow notifications only to installed PWA, and not just any website you visit.
They'd get to claim privacy/user safety (no drive by permissions grab)
But, this eats into their walled garden money pit, so yeah it's not going to happen..