This review explores the use of virtual reality (VR) in the study of moral dilemmas, focusing on both classical paradigms—such as the trolley and footbridge problems—and applied contexts, including driving scenarios and the ethical programming of autonomous vehicles. Drawing on a set of 26 studies, we examine how VR enhances the ecological validity of moral research by allowing participants to engage with immersive, emotionally charged situations that closely resemble real-world dilemmas. We review empirical findings regarding participants’ behavioral and physiological responses, highlighting a general trend toward utilitarian choices in VR, and discuss individual differences, contextual influences, and time constraints as key modulators of moral decision-making. In addition, we address methodological limitations and ethical considerations, including the variability of VR paradigms, logistical challenges, and concerns related to psychological discomfort. We argue that VR not only bridges the gap between judgment and action but also offers a powerful tool for advancing research and training in moral cognition. Finally, we outline future directions, emphasizing the need to extend VR applications beyond driving, increase methodological standardization, and leverage multimodal data collection for a deeper understanding of how moral decisions unfold in dynamic environments.