Here's a rather perilous, but invigorating line of thought I chanced across - while spectating House MD.

Imagine a physician credited with the sustenance of thousands of lives, who's just been assigned the purview of a genocidal autocrat's healthcare (one of the series' episodes was built around this plot).
What are the arguments for, and against him/her deliberately ending this individual's life?

If the aforethought associated with an exercise is egregious or of immoral motive, the intentionalism-based consensus lies in it being an unethical one irrespective of its consequences. Herein, there lies a philosophical necessity of condemnation. If its influences are serendipitous, the consequentialist and utilitarian perspectives will be approving, and vice versa. Conversely, if a morally premeditated act eventually exhibits unfavorable ramifications, the dynamic is reversed. Intent is granted, but utilitarian satisfaction is not. The two appear to be founded on antithetical modes of reason.

Here are two matrices that describe the above.
https://imgur.com/a/1ONuiKS

My understanding may be flawed. If these relations are not concretely defined, I'd love to know.

If they are concretely defined, however, the only available overlap is an unequivocally moral exercise that is characterized by both commendable intent and consequence. Most acts are not subject to this definition, meaning that one must necessarily rationalize them in another way in order to satisfy both philosophical standards.

Since consequences are objectively determinate, it seems natural to use the ambiguity of intent to one's advantage. Returning to the hypothetical circumstance listed above, does the practitioner in question possess the right to redefine his intent for himself, and thus, ascribe to himself a moral stature?

For instance, a physician placed in the conundrum may elect to be adaptable, and assume either of the following intents:

A) Apprehending against, and eliminating the eventuality of political genocide
B) Deliberately dispossessing a waking, sentient individual of his life and bereaving his family and friends of him/her

One may choose to disregard intent B, and instead pursue a valorous cause with an 'ends justifying their means' motive. Of course, there's no mechanism whereby you can commit what is, essentially an act of homicide, without intending to do so. That's merely impractical. It's just the case, that the first intent is relatively accentuated in the moments leading up to the act - allowing it to supersede one's compunctions against the second.

There is another uncertainty to be grappled with: if an immoral intent is passive, and does not actively manifest, can it be forgiven upon a utilitarian outcome? Even if one is constituting their judgement on a distilled basis of intent, can an intractably immoral motive be overlooked if a more meaningful one is at play?

If this inconsistency is resolved, one may ask posit an even greater abstraction:
Are intentionalism and consequentialism fundamentally irreconcilable, with one another? If not, how might one construct an epistemology that integrates the two?