On January 21 2011, in R. v. Cox, 2011 ONCA 58 (CanLII ), the Ontario Court of Appeal dismissed an appeal against conviction and sentence by Allison Cox who had been convicted on February 1, 2008 of manslaughter, criminal negligence causing death, and failure to provide the necessaries of life in the death of her sister Tiffany Pinckney diagnosed with Autism Disorder and profound developmental delay. The Court of Appeal reviewed a number of arguments made by Ms Cox's counsel with respect to the convictions and the sentence and dismissed them without need to hear from the prosecution. The Pinckney case is one of the most horrific examples of the vulnerability of those with severe autism disorder and limited communication skills.
In dismissing the appeal the Court of Appeal reviewed the facts:
" At age two, Tiffany was diagnosed with an Autism Disorder and as profoundly developmentally delayed. As a result, Tiffany’s communication skills were severely delayed. She communicated mostly through gestures, pointing, and sounds, though she had some single words. At age 15, her language skills were less than those of a three year old child.
 Ms. Cox met Orlando Klass in 1995. He moved into the residence of Ms. Cox and her family and in 2002 Ms. Cox and Mr. Klass were married. In 2004 they, along with their three children and Tiffany, moved into a residence on Fairwind Drive. Tiffany lived in the basement.
 There was no washroom in the basement, nor was there any access to running water, or food. Tiffany’s bed consisted of a metal bed frame with two pieces of wood on top, covered with a deflated rubber air mattress which was blood-stained and dirty with fecal matter. There were no sheets and there was a filthy pillow with fecal matter on it.
 The rest of the house was fairly typical of a large suburban home, and relatively clean and tidy. However, there was a lock on the refrigerator in the kitchen. The door to the basement also had a lock on it which could only be locked or unlocked from the main floor.
 Ms. Cox was the primary caregiver for Tiffany. She stayed at home caring for Tiffany and her children. Ms. Cox failed to take Tiffany to a doctor in the five years prior to Tiffany’s death, she declined many efforts at assistance by community service providers, and she denied others who cared about Tiffany access to her.
 Mr. Klass worked full-time, as much as 70 hours a week. He would assist his wife to care for Tiffany after work and on the weekends.
 On April 2, 2005, Mr. Klass decided to go to the basement because Tiffany had not eaten all day. Tiffany was lying dead on an area rug on the cement floor. Mr. Klass nudged her with his foot, but she was non-responsive. He decided to wait until the appellant returned home from a birthday party a few hours later before he called emergency personnel.
 Tiffany was lying on the floor with fecal matter on her skin and clothing, and numerous cuts and bruises on her body. Fecal matter was visible all over the basement, including on the floors and walls. The basement was partially finished, but Tiffany was in an unfinished part with a filthy area rug, a TV, and dresser. According to testimony at trial, the smell of bleach was in the air and there were visible damp spots on the concrete floor. Mr. Klass had tried to clean the basement with a mop before he called 911.
 For most of her life, Tiffany was heavy-set. She overate and between the ages of 16 and 20 met the profile for obesity. During those years she was estimated to have weighed up to 200 pounds. Following her mother’s death, however, her weight declined and at the time of death she weighed 84.5 pounds. The normal weight for a young woman her height – 5 feet, 2 inches – was 125 pounds.
 Dr. Huyer, the Coroner, testified that it appeared Tiffany had been dead for some time prior to being discovered and that she had likely died a day earlier. The Crown’s medical experts testified that Tiffany died as a result of complications from malnourishment, while a defence expert expressed the opinion that the cause of death was inconclusive.
 Mr. Klass’ conduct constituted a marked departure from that expected of a reasonable person in the circumstances. He pled guilty to criminal negligence causing death at the earliest opportunity, acknowledging that Tiffany was not properly cared for or nourished, and that he did not take any steps to rectify the situation."
Allison Cox, Tiffany Pinckney's adopted sister was her primary caregiver. In analyzing her counsel's legal arguments the Court of Appeal noted:
"The findings of fact in our case include that:
• Tiffany died of malnutrition caused by starvation, which was constant over a long period of time;
• Tiffany was not taken to a doctor for the five years before her death;
• Tiffany lived in conditions that were appalling and she was covered in filth and excrement when she died;
• There was a lock on the refrigerator in the kitchen and the door to the basement had a lock on it that could only be unlocked from the main floor. There was no access to food, water, or a washroom in the basement;
Ms. Cox rebuffed virtually all efforts to assist Tiffany in the last three years of Tiffany’s life."
In Canada the Ontario Courts held Tiffany Pinckney's caregivers criminally responsible for the horrendous abuse to which they subjected Tiffany Pinckney and for her death which resulted from that abuse. They did not blame Tiffany Pinckney, or her autism disorder, or her developmental delay, or inability to communicate for her abuse or for her death. They did note that these disabilities made her vulnerable and took that vulnerability into account in sentencing those responsible.