become an accomplice of harmful acts or crimes. I will mention a few
examples bearing on the sexual question:

A sadist or a sexual pervert addicted to assaults on children consults
a doctor and confides to him his morbid appetite. It is obvious that
the doctor has to do with a dangerous individual and is at the same
time in a difficult position. In this case extreme measures are bad.
The doctor who simply treats the patient without concerning himself
about the possible victims, contravenes his duties. The one who
replies to the patient, "you are a beast; go away or I shall denounce
you," acts in a still worse manner. The one who simply denounces the
patient also puts himself in the wrong. In my opinion, the doctor
should first of all make a thorough examination of the mental and
sexual condition of the patient, so as to establish the degree of
perversion and satisfy himself whether he has to do with an honest
individual worthy of pity, who strives to overcome his morbid
appetite; or, with a crafty egoist with no conscience, who only
consults the doctor to escape from temporary difficulties into which
his perversion has led him, and who indulges his morbid appetite
without scruple, constituting a perpetual danger to society.
Unfortunately, the latter cases are very common, and the doctor is
usually consulted from interested motives only. Under these
circumstances medical secrecy renders the doctor the accomplice of the
criminal.

Between the honest patient and one who is absolutely perverse, there
are many transitional stages. In these cases the doctor should always
make a careful examination before forming an opinion. If he feels
uncertain, he should call in a specialist in mental disease, and then
act accordingly. If he is convinced that the patient has made the
resolution to overcome his morbid appetite, and has so far resisted
the temptation to injure any one, he should strengthen the patient's
resistance by doing everything possible (except marriage) to rid him
of his malady; he should make him aware how dangerous his condition is
to himself and to others; he may even recommend either castration or
masturbation in case of urgency, in order to avoid crime; he should
make him promise to come immediately for internment in an asylum, as
soon as he can no longer resist. Under these conditions he may respect
medical secrecy and at the same time save the existence of the
unfortunate patient, while protecting society.