Russell West (defendant), and his wife, Ann (defendant), voluntarily cared for Russell’s 54-year-old disabled sister, Lillian. Lillian, who had Down syndrome and a heart ailment, lived with the Wests. Lillian participated in activities at a local health organization that provided services to mentally handicapped persons. After four years of Lillian’s participation, Russell discontinued her involvement with the organization. Shortly before her death, Lillian’s health began to decline, and she was confined to her bed. Russell delivered Lillian to the hospital’s emergency room. The physician who examined Lillian was alarmed by her physical condition and referred the matter to a social worker to investigate Lillian’s home environment. Approximately three weeks later, Lillian died. The Commonwealth of Kentucky (plaintiff) indicted Russell for second-degree manslaughter and indicted Ann as a complicitor. At trial, medical witnesses testified that Lillian had numerous bedsores in various stages of development, was severely malnourished, and had other ailments. The physicians testified that Lillian died of sepsis and pneumonia caused by the bedsores. Additionally, the doctors testified that the Wests’ neglect led to Lillian’s death. A jury convicted Russell and Ann, and they appealed.