This paper introduces a novel Payoff-Trolley dilemma task, where other participants’ payoffs were at stake on the main or sidetrack in a trolley dilemma. Different scenarios varied the number of “others’ payoffs” on the sidetrack and main track in ways that helped identify more clearly immoral choices of commission and omission, and utilitarian choices. Study participants had also made hypothetical Trolley dilemma choices in a separate study 4-5 years prior, allowing for a direct comparison of hypothetical and consequential moral dilemma choices. One key finding is that past hypothetical choices are statistically significant predictors of present consequential choices in the Payoff-Trolley task. Also, we find that one’s degree of cognitive reflection is the most robust person-specific characteristic that predicts choices—higher cognitive reflection predicts more utilitarian choices, a reduced likelihood of immoral acts of commission and omission, and it impacts one’s sensitivity to immoral choices for a given level of net-harm present in the scenario. These results hope to bridge a gap in our understanding of how choices in hypothetical moral dilemmas inform behaviors in consequential moral dilemmas.