Damage to the ventromedial prefrontal cortex (VMPC) increases utilitarian moral judgments. Six patients with bilateral VMPC damage showed an abnormal tendency to make utilitarian decisions in moral dilemmas involving conflicting considerations of aggregate welfare and emotionally aversive actions. These patients had normal moral judgments in other types of dilemmas. The study suggests that the VMPC is critical for normal moral judgments in specific dilemmas where social emotions play a key role. The findings support the idea that emotions are necessary for moral judgments. The study also highlights that VMPC damage affects emotional processing and social emotions, but does not impair general intelligence, logical reasoning, or knowledge of social and moral norms. The results indicate that VMPC patients rely on explicit norms to make decisions in high-conflict scenarios, leading to abnormal judgments. The study emphasizes the role of emotional processes in moral judgment and the importance of the VMPC in resolving moral conflicts involving social emotions. The findings suggest that the VMPC is a critical neural substrate for intuitive/affective but not for conscious/rational systems in moral judgment.Damage to the ventromedial prefrontal cortex (VMPC) increases utilitarian moral judgments. Six patients with bilateral VMPC damage showed an abnormal tendency to make utilitarian decisions in moral dilemmas involving conflicting considerations of aggregate welfare and emotionally aversive actions. These patients had normal moral judgments in other types of dilemmas. The study suggests that the VMPC is critical for normal moral judgments in specific dilemmas where social emotions play a key role. The findings support the idea that emotions are necessary for moral judgments. The study also highlights that VMPC damage affects emotional processing and social emotions, but does not impair general intelligence, logical reasoning, or knowledge of social and moral norms. The results indicate that VMPC patients rely on explicit norms to make decisions in high-conflict scenarios, leading to abnormal judgments. The study emphasizes the role of emotional processes in moral judgment and the importance of the VMPC in resolving moral conflicts involving social emotions. The findings suggest that the VMPC is a critical neural substrate for intuitive/affective but not for conscious/rational systems in moral judgment.