With the Catholic Church rocked by a devastating US report into child sex abuse, Pope Francis has this week sharpened his critcism on the explosive issue -- but he remains under pressure to enact far-reaching changes.
The US grand jury report accused more than 300 "predator" priests in the state of Pennsylvania of abusing more than 1,000 children over seven decades, sparking a fresh bout of soul-searching among senior Catholics across the world.
"The clock is ticking for all of us in Church leadership. Catholics have lost patience with us and civil society has lost confidence in us," Cardinal Sean O'Malley, the archbishop of Boston, who has been advising the pope on the issue, said in a statement last week.
The archbishop of Dublin, Diarmuid Martin, added: "It is not enough just to say sorry. Structures that permit or facilitate abuse must be broken down and broken down forever.
"Why does this not happen? Why must such a simple affirmation have to be repeated so often?" he said at a weekend mass in the Irish capital.
Martin, who will welcome the pope this weekend on his visit to Ireland -- a country where abuse scandals have dealt profound blows to the Church's credibility -- said he believes the Vatican's commission is too small to be effective.
Amid harrowing details of abuse, the US report directs this scathing comment to the Church hierarchy: "Priests were raping little boys and girls, and the men of God who were responsible for them not only did nothing; they hid it all. For decades."
The report once again puts the spotlight on Pope Francis, who has been criticised for not acting quickly enough to clamp down on the sprawling cases of abuse as well as for a reluctance to distance himself from certain cardinals suspected of omerta.
"With shame and repentance, we acknowledge as an ecclesial community that we were not where we should have been, that we did not act in a timely manner, realising the magnitude and the gravity of the damage done to so many lives. We showed no care for the little ones," the pontiff said in his letter earlier this week.
At the end of May, the Argentinian pope wrote a letter to the people of Chile, where an unfolding abuse scandal has sparked an impassioned debate.
This week in an unprecedented letter he addressed all of the globe's 1.3 billion Catholics about the "atrocities" of abuse.
- 'Excuses aren't enough' -
While Francis acknowledged the work being done in some parts of the world to protect children, he admitted that the Church had "delayed" in applying the necessary sanctions.
The pope "did not, however, offer any new specifics" on possible new accountability measures, said American Vatican-watcher John Allen, noting that Francis did not make a single mention of the word "bishop".
"Among great swathes of public opinion, the idea is beginning to gain traction that mea culpas, statements and meetings with victims are not enough any more," according to Marco Politi, an Italian Vatican expert.
"It is now up to Francis to act as supreme legislator" by modifying the Church's canon law, Politi wrote in the Fatto Quotidiano newspaper.
He added that there were already "virtuous examples" in this area in the United States, Britain and Germany.
Journalist Emiliano Fittipaldi, who has carried out several investigations into the workings of the Church, told AFP that Francis could go further.
"The pope could force bishops' conferences to send recent reports of abuse to judicial authorities," he said. "Excuses aren't enough any more."
That is a sentiment echoed by many abuse victims.
"We don't want a trial within the Vatican!" said Francesco Zanardi, leader of an Italian abuse survivors' association.
According to Vatican-focused blog "Il Sismografo," the pope could soon publish specific guidelines for bishops on how to handle abuse claims -- but the Vatican has not confirmed this.
In 2016, Francis instigated a change in canon law which meant bishops could be removed if they were found to be "negligent" in the face of reports of paedophilia.
However, within Church law there is no wider requirement to report cases to the relevant judicial authorities. In certain countries this is a legal obligation but in others, bishops are loath to make it a rule.
Some commentators are also urging the Church to use its response to the crisis to undertake a reconsideration of its stance on celibacy.
In an opinion article published this week in French newspaper Le Monde, French-Canadian writer Nancy Huston appealed to the pontiff to abolish celibacy for priests and recognise the importance of sexuality for human well-being.
But even though Pope Francis said in 2014 that "celibacy is not a dogma", the Vatican does not yet seem ready to take the step of ending the practice.