Sorry to piss all over the paedophile's parade, but recent research has shown that the claim to have been abused as a child as explanation for paedophilia is likely to be another form of manipulation. The research first recorded the numer of participants (all convicted paeophiles in the UK) who claimed they had been abused as a child. Although I can't remember exact numbers (research still pending publication), it was something like 78% of them claimed to have been abused as children. The participants were then put through a "lie detector", and those claiming to have been abused dropped to ~40% with questions marks being raised to a further percentage because the polygraph recorded stressed answers. However, that's irrelevant to your question. In short, I think there are two issues: 1 - When is someone not responsible for their actions? In short, whenever they are not in control of their perceptions and behaviour. That means psychotic patients are not responsible. It means that anti-social personality disorder patients are responsible. It means that paedophiles are responsible. It means that the line of responsibility for addicts is blurred, but (I have The Ultimate Test coming up) not so much that they are blame-free. The Ultimate Test: could the person restrain themselves from committing their offence in front of a police officer? If yes, responsible. If no, probably not responsible. Serial killers, child sexual abusers and addicts tend not to offend in front of police officers, thus one must conclude that they are entirely capable of regulating their behaviour. 2 - How do we make these people to take responsibility for their actions? That's a good question, but I can tell how we don't do it. We don't do it by withholding medical care, we don't do it by being judgemental whilst delivering medical care, we don't do it by delivering substandard medical care. Doing any of those things is not in the patient's interest. We are charged to "first, do no harm" and as a humanist, that is my first responsibility. (Of course, if the patient is abusive to the health care provider then for the protection of ourselves from harm, we must withdraw ourselves.) As tempting as it is, if we don't provide impartial, quality care then we will not be trusted and this will cause long term harm. (PS - That doesn't mean you can't be frustrated by it afterwards!)