Many of the examples in the article are constructed to omit outside observers. In the real world, this is very unrealistic. Our intuitions about the importance of acting consistently reflect the risk that we'll be discovered doing something abhorrent. Reputation is important.
In fact, if we make the examples more abstract and impersonal, then it's much easier to see how utilitarianism makes sense. What if there was no actor making a choice; instead, the two possible outcomes happen by chance or natural causes. Say the healthy patient dies from a freak accident, allowing other patients to be saved. This seems like a better outcome than five people dying, all else equal. It's only the possible effect on the doctor's reputation that makes the original a moral dilemma.
Similarly, in the riot example, if the innocent person was implicated by accident, that would be a better outcome than many innocent people dying to the mob. It's only introducing the sheriff and his reputation that makes it a dilemma.