For a while in the late 2000s, it felt like moral choices in games were only going to be a flash-in-the-pan type deal. Mass Effect and GTA IV showcased some of the most meaningful, as various pivotal scenes played out in strikingly different ways depending on what you'd done beforehand.
Then things went pretty quiet... until 2012's The Walking Dead decided the act of choosing dialogue options was the game itself. Telltale's narrative gem came out of nowhere and changed everything all over again, and although the act of branching the experience had existed in games before, The Walking Dead became a definitive step up - one that you can feel the ramifications of in every narrative-driven game to this day.
Back to the choices themselves though; although modern titles feature more branching options than ever, if we're talking about the most meaningful, most gut-wrenching, and most timeless in gaming history, well... they're not going to be pleasant.