This phrase: "responsible for so many deaths" is doing a lot of work in your post. What is your theory of responsibility? Is it legal or ethical, and if it is the latter (as I would suspect), what framework and criteria is it evaluated under?
The answer is easy for a serial killer (obviously responsible for willful murder), a little more difficult for a soldier in war (directly responsible, but perhaps defending themselves and/or under orders), even tougher for a surgeon (maybe they could have been better at their job), and very difficult indeed for an insurance executive.
The answer is easy for a serial killer (obviously responsible for willful murder), a little more difficult for a soldier in war (directly responsible, but perhaps defending themselves and/or under orders), even tougher for a surgeon (maybe they could have been better at their job), and very difficult indeed for an insurance executive.