I look at it from the other end. When a CEO really messes up 1000 or 10,000 people can be fired. There are small towns in America in which 40% of the population works for a single business - towns that will fall apart if the local plant shuts down.
I am not prepared to say that all or even most CEOs have responsibilities that rival a heart surgeon, but the ones heading up large companies probably do.
Someone has to make the decision when the staff says recalling the product will cost X dollars, while not recalling the product will result in approximately 5 deaths - the total payout to the families would be 1/3 of X.
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ETA
Not to harp on the heart surgeon thing, but going back to the opening post, if we surveyed all sorts of people and they said that in a hospital, the highest paid employee can make no more than 4.6 times what the lowest-paid employee earns, then would that be the right way to determine a surgeon's salary? What about professional sports teams. Should the guy who bats .400 be paid only 4.6 times what the guy cleaning the shower stalls earns?
By that logic, sociopaths should be paid less because they don't care. Or is this non-caring something that makes them deserving of higher income?
In any case, there are some crucial differences between the heart surgeon and the CEO. If the heart surgeon screws up he can be sued and might even become guilty of negligent homicide. Of course, so might a school bus driver.
The CEOs responsibility is relatively risk free compared to the surgeon or the school bus driver. It is not so much responsibility as rather power. Neither heart surgeons or school bus drivers can make legal decisions that affect thousands of lives, or make and break entire towns.
Many people like having power. That makes it a fringe benefit. It's not something you need to pay a lot of money to people to accept it. You could easily find people who would pay you for it.
Even if you think current CEO pay is justifiable. How do you justify the meteoric rise over the last decades? Were CEOs underpaid back then? Are they underpaid now? Cause I don't see any stop to that rise.