Sam Harris (my hero) gives a bit of his reasoning:
[youtube]oTrhnS5q2g0[/youtube]
I'm sure I've seen him talk about it in some other video as well. His conclusion was the second scenario is (perhaps) fundamentally different. He reasoned that by pushing the fat man onto the tracks you are agreeing to a kind of bad moral infrastructure.
An example he gave was that if you want to live in a world like this then you may be scared of ever going to the doctor because at any time the doctor may decide to kill you and take your organs to help save the lives of 2 other people (net result +1 life saved). So in the end you are creating fear for many people (e.g. patients) and that outweighs the benefit of saving the workman's lives.
But he doesn't claim to have a definite answer to the issue and I agree it is a very difficult problem. A lot of the issue comes with the exact details of the problem. It is possible to state the problem in such a way that the two scenarios are totally the same. For example you could say the fat guy is also a railway workman. He could also be working down at track level and for example you could be 100% sure he would stop the train if you pushed him onto the track which would short it out, or something similar. I think in the end if you restate the question it becomes very difficult to answer yes to one scenario but no to the other. In the end you get forced to agree that saving X lives is more important than saving Y lives where X is greater than Y.
This whole question might appear to be some perverse riddle to a lot of people but I'm of the firm belief that by shunning these sorts of moral questions (like 90% of people do) they are doing us all a great disservice. By running away from issues like this, people's opinions get incorrectly warped because their 'moral logic' contains large gaps.
This will be viewed as flamebait by many but one example is people who are 100% anti war (i'm not talking about people who are against iraq, that is a complex and reasonable thing to be against). That is they are against war whatever the circumstances. So if deranged leader came to power and started systematically killing civilians until all 4 billion were dead, they would prefer to keep the peace and allow them to continue. I would claim their moral logic is very naive and immature because they refuse to think through these types of hypothetical puzzles.