> Ah, there I think you're adding apples and oranges; the cases aren't related.

?
I tried to purposely construct them such that they had the same form. Lets see if I can do better.

CASE A
Do nothing: 6 people die, 1 person lives
So something: 1 person dies, 6 people live

Most people think that you should do something: It is better to have 1 person die and 6 people live than to have 6 people die and 1 person live.

CASE B
Do nothing: 6 people live, 1 person dies
So something: 1 person lives, 6 people die.

Most people think that the surgeon should do something. The problem is: How do we justify killing 6 to save 1 in the second case? Especially if 'doing the greatest good for the greatest number' was supposed to be our justification for killing the 1 (and not the 6) in case A.

Some people think... Our intuitions in the second case have something to do with a doctor having his duty to do everything in his power to save his patient. That is why I purposely stipulated that all seven people were his patients. Some people think that if the doctor let the one die and word got out then people would take themselves off organ donation lists - which would result in more deaths overall. That is why it is important that nobody ever hears of the doctors decision. Some people think that the second case is psychologically implausible (it is implausible that nobody will find out). That is why I made the island isolated...

I guess I'm not sure on what the relevant difference is supposed to be between the two cases that justifies our going one way on one case and the other way on the other case...