IntroductionCertain professions are particularly exposed to stress and must make decisions with far-reaching consequences. Recent research indicates that stress alters subsequent decision-making. The two current studies examine the predictive effect of perceived stress and leadership responsibility on moral decision-making among emergency service personnel. ObjectiveWe hypothesized that under high levels of perceived stress, fewer utilitarian and fewer altruistic decisions are made. Utilitarian decisions involve saving the lives of more people while sacrificing a smaller number of people. Altruistic decisions lead to outcomes that benefit others rather than oneself. Furthermore, we hypothesized that leaders under high levels of perceived stress make more utilitarian and altruistic decisions than non-leaders. MethodTwo different samples (N1=368; N2=562) were exposed to two different types of moral dilemmas (Sample 1: sacrificial dilemmas, Sample 2: everyday dilemmas). Stress levels were assessed using the Perceived Stress Scale. The hypotheses were tested with hierarchical regression analysis. ResultsAs hypothesized, in sacrificial dilemmas, high perceived stress levels predicted a decrease in utilitarian decisions. Moreover, highly stressed leaders made more utilitarian decisions compared to non-leaders. In everyday dilemmas, high-perceived stress levels predicted fewer altruistic decisions. No moderating effect of leadership responsibility was observed. ConclusionOur results indicate that perceived stress predicts moral decision-making among emergency service personnel.