Very interesting dilemma.

I would kind of cheat though. LOL

In the case of the train I have to kill either way so I'll choose to kill 1 instead of 6.

In the case of the surgeon, I'm not doing the killing directly, but I agree that letting die is basically the same thing as killing. I think I'll need more infomation to decide. I think I'd base my decision on amount of suffering. Whichever choice leads to less suffering is the choice I'd choose. Otherwise I would cheat and flip a coin and let chance decide!