The Judgment-Consequence Gap: LLM Moral Reasoning in Healthcare Decisions

The key question in moral judgement is not simply whether someone chooses the "right" answer, but how they decide what matters most when moral principles conflict. Current evaluations of large language models (LLMs) remain limited: most test whether models give morally acceptable answers, match human preferences, or avoid obvious violations, rather than whether they can prioritise between competing principles when no option is morally cost-free. We introduce CORDA (Conditioned Ordering and Ranked Directive Adherence), a benchmark for evaluating hierarchical, harm-centred moral reasoning in LLMs. Building on the morality chains formalism, CORDA tests 90 moral dilemmas involving trolley-style cases, medical trade-offs, resource allocation, and human-animal-robot conflicts across four ordered ethical frameworks: Utility, Utility + Agent Harm, Dual-Process, and Dual-Process + Agent Harm. Together, these frameworks test whether models can adapt their decisions when moral priorities change. Across ten instruction-tuned models from seven providers, we find a strong deontological default, with 9 of 10 prioritising avoidance of direct personal harm over reducing overall harm. Models also perform more reliably on categorical harm-avoidance rules, such as avoiding killing, than on outcome-based comparisons, such as minimising total harm, suggesting that they recognise moral red lines more easily than they reason through competing harms. Although all models respond to explicit chain conditioning, several fail to consistently follow specified priority orderings, such as humans over animals and animals over robots. CORDA addresses a central gap in LLM moral evaluation by testing whether models can move beyond default harm-avoidant responses and apply context-specified moral priorities. Moral reliability requires more than default restraint; it requires controllability under conflict.

A human's moral decision depends heavily on the context. Yet research on LLM morality has largely studied fixed scenarios. We address this gap by introducing Contextual MoralChoice, a dataset of moral dilemmas with systematic contextual variations known from moral psychology to shift human judgment: consequentialist, emotional, and relational. Evaluating 22 LLMs, we find that nearly all models are context-sensitive, shifting their judgments towards rule-violating behavior. Comparing with a human survey, we find that models and humans are most triggered by different contextual variations, and that a model aligned with human judgments in the base case is not necessarily aligned in its contextual sensitivity. This raises the question of controlling contextual sensitivity, which we address with an activation steering approach that can reliably increase or decrease a model's contextual sensitivity. Code and data: https://github.com/adrian-sauter/contextual_moralchoice.

Human moral judgment is context-dependent and modulated by interpersonal relationships. As large language models (LLMs) increasingly function as decision-support systems, determining whether they encode these social nuances is critical. We characterize machine behavior using the Whistleblower's Dilemma by varying two experimental dimensions: crime severity and relational closeness. Our study evaluates three distinct perspectives: (1) moral rightness (prescriptive norms), (2) predicted human behavior (descriptive social expectations), and (3) autonomous model decision-making. By analyzing the reasoning processes, we identify a clear cross-perspective divergence: while moral rightness remains consistently fairness-oriented, predicted human behavior shifts significantly toward loyalty as relational closeness increases. Crucially, model decisions align with moral rightness judgments rather than their own behavioral predictions. This inconsistency suggests that LLM decision-making prioritizes rigid, prescriptive rules over the social sensitivity present in their internal world-modeling, which poses a gap that may lead to significant misalignments in real-world deployments.