I also wanted to add, I think for the most part, even with MI, actions are a choice. If we let people use their illness as an excuse it not only allows them to get away with doing wrong but also harms everyone else who may have these thoughts, yet makes the choice not to act on them.

I think the exception is someone who is delusional and does NOT know right from wrong. But they won't be able to say "I'm having these thoughts but I know better than to act on them." There's a big difference, it's not hard to figure out.