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Karmic Dice - yes or no?
(bg3.wiki)
Baldur’s Gate 3 is a story-rich, party-based RPG set in the universe of Dungeons & Dragons, where your choices shape a tale of fellowship and betrayal, survival and sacrifice, and the lure of absolute power. (Website)
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I play with it off, because I prefer to not have my rolls messed with in either direction. I don't personally want to play with it giving me an artificial bonus and then likely dumping on me the next time I roll.
As someone else stated, if you don't know what you're doing keep it on for the sake of gameplay. Otherwise turn it off if you don't want it
I assume it is possible to switch it on of off anytime during the campaign.
It's an overall game setting, so yes. Thankfully you don't have to worry about making the choice before starting