This does totally defy the intuitive understanding of expected utility. Intuitively, you can just set your utility function as whatever you want. If you want to maximize something like saving human lives, you can do that. As in one person dying is exactly half as bad as 2 people dying, which itself is exactly half as bad as 4 people dying, etc.
The justification for expected utility is that as the number of bets you take approach infinity, it becomes the optimal strategy. You save the most lives than you would with any other strategy. You lose some people on some bets, but gain many more on other bets.
But this justification and intuitive understanding totally breaks down in the real world. Where there are finite horizons. You don't get to take an infinite number of bets. An agent following expected utility will just continuously bet away human lives on mugger-like bets, without ever gaining anything. It will always do worse than other strategies.
You can do some tricks to maybe fix this somewhat by modifying the utility function. But that seems wrong. Why are 2 lives not twice as valuable as 1 life. Why are 400 lives not twice as valuable as 200 lives? Will this change the decisions you make in everyday, non-muggle/excessively low probability bets? It seems like it would.
Or we could just keep the intuitive justification for expected utility, and generalize it to work on finite horizons. There are some proposals for methods that do this like mean of quantiles.
I don't think that "the justification for expected utility is that as the number of bets you take approach infinity, it becomes the optimal strategy," is quite true. Kaj did say something similar to this, but that seems to me a problem with his approach.
Basically, expected utility is supposed to give a mathematical formalization to people's preferences. But consider this fact: in itself, it does not have any particular sense to say that "I like vanilla ice cream twice as much as chocolate." It makes sense to say I like it more than choc...
Summary: the problem with Pascal's Mugging arguments is that, intuitively, some probabilities are just too small to care about. There might be a principled reason for ignoring some probabilities, namely that they violate an implicit assumption behind expected utility theory. This suggests a possible approach for formally defining a "probability small enough to ignore", though there's still a bit of arbitrariness in it.