introduction of legal case study

How to write a case brief for law school: Excerpt reproduced from Introduction to the Study of Law: Cases and Materials,

Third Edition (LexisNexis 2009) by Michael Makdisi & John Makdisi

C. HOW TO BRIEF

The previous section described the parts of a case in order to make it easier to read and identify the pertinent information that you will use to create your briefs. This section will describe the parts of a brief in order to give you an idea about what a brief is, what is helpful to include in a brief, and what purpose it serves. Case briefs are a necessary study aid in law school that helps to encapsulate and analyze the mountainous mass of material that law students must digest. The case brief represents a final product after reading a case, rereading it, taking it apart, and putting it back together again. In addition to its function as a tool for self-instruction and referencing, the case brief also provides a valuable “cheat sheet” for class participation.

Who will read your brief? Most professors will espouse the value of briefing but will never ask to see that you have, in fact, briefed. As a practicing lawyer, your client doesn’t care if you brief, so long as you win the case. The judges certainly don’t care if you brief, so long as you competently practice the law. You are the person that the brief will serve! Keep this in mind when deciding what elements to include as part of your brief and when deciding what information to include under those elements.

What are the elements of a brief? Different people will tell you to include different things in your brief. Most likely, upon entering law school, this will happen with one or more of your instructors. While opinions may vary, four elements that are essential to any useful brief are the following:

(a) Facts (name of the case and its parties, what happened factually and procedurally, and the judgment)

(b) Issues (what is in dispute)

(c) Holding (the applied rule of law)

(d) Rationale (reasons for the holding)

If you include nothing but these four elements, you should have everything you need in order to recall effectively the information from the case during class or several months later when studying for exams.

Because briefs are made for yourself, you may want to include other elements that expand the four elements listed above. Depending on the case, the inclusion of additional elements may be useful. For example, a case that has a long and important section expounding dicta might call for a separate section in your brief labeled: Dicta. Whatever elements you decide to include, however, remember that the brief is a tool intended for personal use. To the extent that more elements will help with organization and use of the brief, include them. On the other hand, if you find that having more elements makes your brief cumbersome and hard to use, cut back on the number of elements. At a minimum, however, make sure you include the four elements listed above.

Elements that you may want to consider including in addition to the four basic elements are:

(e) Dicta (commentary about the decision that was not the basis for the decision)

(f) Dissent (if a valuable dissenting opinion exits, the dissent’s opinion)

(g) Party’s Arguments (each party’s opposing argument concerning the ultimate issue)

(h) Comments (personal commentary)

Personal comments can be useful if you have a thought that does not fit elsewhere. In the personal experience of one of the authors, this element was used to label cases as specific kinds (e.g., as a case of vicarious liability) or make mental notes about what he found peculiar or puzzling about cases. This element allowed him to release his thoughts (without losing them) so that he could move on to other cases.

In addition to these elements, it may help you to organize your thoughts, as some people do, by dividing Facts into separate elements:

(1) Facts of the case (what actually happened, the controversy)

(2) Procedural History (what events within the court system led to the present case)

(3) Judgment (what the court actually decided)

Procedural History is usually minimal and most of the time irrelevant to the ultimate importance of a case; however, this is not always true. One subject in which Procedure History is virtually always relevant is Civil Procedure.

When describing the Judgment of the case, distinguish it from the Holding. The Judgment is the factual determination by the court, in favor of one party, such as “affirmed,” “reversed,” or “remanded.” In contrast, the Holding is the applied rule of law that serves as the basis for the ultimate judgment.

Remember that the purpose of a brief is to remind you of the important details that make the case significant in terms of the law. It will be a reference tool when you are drilled by a professor and will be a study aid when you prepare for exams. A brief is also like a puzzle piece.

The elements of the brief create the unique shape and colors of the piece, and, when combined with other pieces, the picture of the common law takes form. A well-constructed brief will save you lots of time by removing the need to return to the case to remember the important details and also by making it easier to put together the pieces of the common law puzzle.

D. EXTRACTING THE RELEVANT INFORMATION: ANNOTATING AND HIGHLIGHTING

So now that you know the basic elements of a brief, what information is important to include under each element? The simple answer is: whatever is relevant. But what parts of a case are relevant? When you read your first few cases, you may think that everything that the judge said was relevant to his ultimate conclusion. Even if this were true, what is relevant for the judge to make his decision is not always relevant for you to include in your brief. Remember, the reason to make a brief is not to persuade the world that the ultimate decision in the case is a sound one, but rather to aid in refreshing your memory concerning the most important parts of the case.

What facts are relevant to include in a brief? You should include the facts that are necessary to remind you of the story. If you forget the story, you will not remember how the law in the case was applied. You should also include the facts that are dispositive to the decision in the case. For instance, if the fact that a car is white is a determining factor in the case, the brief should note that the case involves a white car and not simply a car. To the extent that the procedural history either helps you to remember the case or plays an important role in the ultimate outcome, you should include these facts as well.

What issues and conclusions are relevant to include in a brief? There is usually one main issue on which the court rests its decision. This may seem simple, but the court may talk about multiple issues, and may discuss multiple arguments from both sides of the case. Be sure to distinguish the issues from the arguments made by the parties. The relevant issue or issues, and corresponding conclusions, are the ones for which the court made a final decision and which are binding. The court may discuss intermediate conclusions or issues, but stay focused on the main issue and conclusion which binds future courts.

What rationale is important to include in a brief? This is probably the most difficult aspect of the case to determine. Remember that everything that is discussed may have been relevant to the judge, but it is not necessarily relevant to the rationale of the decision. The goal is to remind yourself of the basic reasoning that the court used to come to its decision and the key factors that made the decision favor one side or the other.

A brief should be brief! Overly long or cumbersome briefs are not very helpful because you will not be able to skim them easily when you review your notes or when the professor drills you. On the other hand, a brief that is too short will be equally unhelpful because it lacks sufficient information to refresh your memory. Try to keep your briefs to one page in length. This will make it easy for you to organize and reference them.

Do not get discouraged. Learning to brief and figuring out exactly what to include will take time and practice. The more you brief, the easier it will become to extract the relevant information.

While a brief is an extremely helpful and important study aid, annotating and highlighting are other tools for breaking down the mass of material in your casebook. The remainder of this section will discuss these different techniques and show how they complement and enhance the briefing process.

Annotating Cases

Many of you probably already read with a pencil or pen, but if you do not, now is the time to get in the habit. Cases are so dense and full of information that you will find yourself spending considerable amounts of time rereading cases to find what you need. An effective way to reduce this time is to annotate the margins of the casebook. Your pencil (or pen) will be one of your best friends while reading a case. It will allow you to mark off the different sections (such as facts, procedural history, or conclusions), thus allowing you to clear your mind of thoughts and providing an invaluable resource when briefing and reviewing.

You might be wondering why annotating is important if you make an adequate, well-constructed brief. By their very nature briefs cannot cover everything in a case. Even with a thorough, well-constructed brief you may want to reference the original case in order to reread dicta that might not have seemed important at the time, to review the complete procedural history or set of facts, or to scour the rationale for a better understanding of the case; annotating makes these tasks easier. Whether you return to a case after a few hours or a few months, annotations will swiftly guide you to the pertinent parts of the case by providing a roadmap of the important sections. Your textual markings and margin notes will refresh your memory and restore specific thoughts you might have had about either the case in general or an individual passage.

Annotations will also remind you of forgotten thoughts and random ideas by providing a medium for personal comments.

In addition to making it easier to review an original case, annotating cases during the first review of a case makes the briefing process easier. With adequate annotations, the important details needed for your brief will be much easier to retrieve. Without annotations, you will likely have difficulty locating the information you seek even in the short cases. It might seem strange that it would be hard to reference a short case, but even a short case will likely take you at least fifteen to twenty-five minutes to read, while longer cases may take as much as thirty minutes to an hour to complete. No matter how long it takes, the dense material of all cases makes it difficult to remember all your thoughts, and trying to locate specific sections of the analysis may feel like you are trying to locate a needle in a haystack. An annotation in the margin, however, will not only swiftly guide you to a pertinent section, but will also refresh the thoughts that you had while reading that section.

When you read a case for the first time, read for the story and for a basic understanding of the dispute, the issues, the rationale, and the decision. As you hit these elements (or what you think are these elements) make a mark in the margins. Your markings can be as simple as “facts” (with a bracket that indicates the relevant part of the paragraph). When you spot an issue, you may simply mark “issue” or instead provide a synopsis in your own words. When a case sparks an idea — write that idea in the margin as well — you never know when a seemingly irrelevant idea might turn into something more.

Finally, when you spot a particularly important part of the text, underline it (or highlight it as described below).

With a basic understanding of the case, and with annotations in the margin, the second read-through of the case should be much easier. You can direct your reading to the most important sections and will have an easier time identifying what is and is not important. Continue rereading the case until you have identified all the relevant information that you need to make your brief, including the issue(s), the facts, the holding, and the relevant parts of the analysis.

Pencil or pen — which is better to use when annotating? Our recommendation is a mechanical pencil. Mechanical pencils make finer markings than regular pencils, and also than ballpoint pens. Although you might think a pencil might smear more than a pen, with its sharp point a mechanical pencil uses very little excess lead and will not smear as much as you might imagine. A mechanical pencil will also give you the freedom to make mistakes without consequences. When you first start annotating, you may think that some passages are more important than they really are, and therefore you may resist the urge to make a mark in order to preserve your book and prevent false guideposts. With a pencil, however, the ability to erase and rewrite removes this problem.

Highlighting

Why highlight? Like annotating, highlighting may seem unimportant if you create thorough, well-constructed briefs, but highlighting directly helps you to brief. It makes cases, especially the more complicated ones, easy to digest, review and use to extract information.

Highlighting takes advantage of colors to provide a uniquely effective method for reviewing and referencing a case. If you prefer a visual approach to learning, you may find highlighting to be a very effective tool.

If annotating and highlighting are so effective, why brief? Because the process of summarizing a case and putting it into your own words within a brief provides an understanding of the law and of the case that you cannot gain through the process of highlighting or annotating.

The process of putting the case into your own words forces you to digest the material, while annotating and highlighting can be accomplished in a much more passive manner.

What should you highlight? Similar to annotating, the best parts of the case to highlight are those that represent the needed information for your brief such as the facts, the issue, the holding and the rationale.

Unlike annotating, highlighting provides an effective way to color code, which makes referring to the case even easier. In addition, Highlighters are particularly useful in marking off entire sections by using brackets. These brackets will allow you to color-code the case without highlighting all the text, leaving the most important phrases untouched for a more detailed highlight marking or underlining.

Highlighting is a personal tool, and therefore should be used to the extent that highlighting helps, but should be modified in a way that makes it personally time efficient and beneficial. For instance, you might combine the use of annotations in the margins with the visual benefit of highlighting the relevant text. You may prefer to underline the relevant text with a pencil, but to use a highlighter to bracket off the different sections of a case. Whatever you choose to do, make sure that it works for you, regardless of what others recommend. The techniques in the remainder of this section will describe ways to make full use of your highlighters.

First, buy yourself a set of multi-colored highlighters, with at least four, or perhaps five or six different colors. Yellow, pink, and orange are usually the brightest. Depending on the brand, purple and green can be dark, but still work well. Although blue is a beautiful color, it tends to darken and hide the text.

Therefore we recommend that you save blue for the elements that you rarely highlight.

For each different section of the case, choose a color, and use that color only when highlighting the section of the case designated for that color. Consider using yellow for the text that you tend to highlight most frequently. Because yellow is the brightest, you may be inclined to use yellow for the Conclusions in order to make them stand out the most. If you do this, however, you will exhaust your other colors much faster than yellow and this will require that you purchase an entire set of new highlighters when a single color runs out because colors such as green are not sold separately. If instead you choose to use yellow on a more frequently highlighted section such as the Analysis, when it comes time to replace your yellow marker, you will need only to replace your yellow highlighter individually. In the personal experience on one of the authors, the sections of cases that seemed to demand the most highlighter attention were the

Facts and the Analysis, while the Issues and Holdings demanded the least. Other Considerations and

Procedural History required lots of highlighting in particular cases although not in every case.

Experiment if you must, but try to choose a color scheme early on in the semester and stick with it. That way, when you come back to the first cases of the semester, you will not be confused with multiple color schemes. The basic sections of a case for which you should consider giving a different color are:

(b) Procedural History

(c) Issue (and questions presented)

(d) Holding (and conclusions)

(e) Analysis (rationale)

(f) Other Considerations (such as dicta)

Not all of these sections demand a separate color. You may find that combining Facts and Procedural History or Issues and Holdings works best. Furthermore, as mentioned above, some sections may not warrant highlighting in every case (e.g., dicta probably do not need to be highlighted unless they are particularly important). If you decide that a single color is all that you need, then stick to one, but if you find yourself highlighting lots of text from many different sections, reconsider the use of at least a few different colors. Highlighters make text stand out, but only when used appropriately. The use of many colors enables you to highlight more text without reducing the highlighter’s effectiveness. Three to four colors provides decent color variation without the cumbersomeness of handling too many markers.

Once you are comfortable with your color scheme, determining exactly what to highlight still may be difficult. Similar to knowing what to annotate, experience will perfect your highlighting skills. Be careful not to highlight everything, thus ruining your highlighters’ effectiveness; at the same time, do not be afraid to make mistakes.

Now that we have covered the basics of reading, annotating, highlighting, and briefing a case, you are ready to start practicing. Keep the tips and techniques mentioned in this chapter in mind when you tackle the four topics in the remainder of this book. If you have difficultly, refer back to this chapter to help guide you as you master the case method of study and the art of using the common law.

More Helpful Links

The american legal system, how to brief a case, how to read a casebook 101, top 20 things you need to know about law school, learn to spot issues like a lawyer, why an internet search is not legal research, why go to law school, what’s the most challenging part of law school, what advice would you give yourself about law school.

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Case Law Research Guide

Introduction.

• Print Case Reporters
• Online Resources for Cases
• Finding Cases: Digests, Headnotes, and Key Numbers
• Finding Cases: Terms & Connectors Searching

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Every law student and practicing attorney must be able to find, read, analyze, and interpret case law. Under the common law principles of stare decisis, a court must follow the decisions in previous cases on the same legal topic. Therefore, finding cases is essential to finding out what the law is on a particular issue.

This guide will show you how to read a case citation and will set out the sources, both print and online, for finding cases. This guide also covers how to use digests, headnotes, and key numbers to find case law, as well as how to find cases through terms and connectors searching.

To find cases using secondary sources, such as legal encyclopedias or legal treatises, see our Secondary Sources Research Guide . For additional strategies to find cases, like using statutory annotations or citators, see our  Case Law Research Tutorial . Our tutorial also covers how to update cases using citators (Lexis’ Shepard’s tool and Westlaw’s KeyCite).

Basic Case Citation

A case citation is a reference to where a case (also called a  decision  or an  opinion  ) is printed in a book. The citation can also be used to retrieve cases from  Westlaw  and  Lexis . A case citation consists of a volume number, an abbreviation of the title of the book or other item, and a page number.  

The precise format of a case citation depends on a number of factors, including the jurisdiction, court, and type of case. You should review the rest of this section on citing cases (and the relevant rules in  The Bluebook ) before trying to format a case citation for the first time. See our Bluebook Guide for more information.

The basic format of a case citation is as follows:

Parallel Citations

When the same case is printed in different books, citations to more than one book may be given. These additional citations are known as  parallel citations .

Example: 265 U.S. 274, 68 L. Ed. 1016, 44 S. Ct. 565.

This means that the case you would find at page 565 of volume 44 of the  Supreme Court Reporter  (published by West) will be the same case you find on page 1016 of volume 68 of  Lawyers' Edition  (published by Lexis), and both will be the same as the opinion you find in the official government version,  United States Reports . Although the text of the opinion will be identical, the added editorial material will differ with each publisher.

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Legal Research: A Guide to Case Law

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Authors: Emily Carr, Senior Legal Reference Librarian, Law Library of Congress

Elizabeth Osborne, Senior Legal Reference Librarian, Law Library of Congress

Editors: Barbara Bavis, Bibliographic and Research Instruction Librarian, Law Library of Congress

Anna Price, Legal Reference Librarian, Law Library of Congress

Note: This guide is adapted from a research guide originally published on the Law Library's website .

Created: September 9, 2019

Last Updated: February 1, 2023

Each branch of government produces a different type of law. Case law is the body of law developed from judicial opinions or decisions over time (whereas statutory law comes from legislative bodies and administrative law comes from executive bodies). This guide introduces beginner legal researchers to resources for finding judicial decisions in case law resources. Coverage includes brief explanations of the court systems in the United States; federal and state case law reporters; basic Bluebook citation style for court decisions; digests; and online access to court decisions.

Court Systems and Decisions

The United States has parallel court systems, one at the federal level, and another at the state level. Both systems are divided into trial courts and appellate courts. Generally, trial courts determine the relevant facts of a dispute and apply law to these facts, while appellate courts review trial court decisions to ensure the law was applied correctly.

Stare Decisis (Precedent)

In Latin, stare decisis means "to stand by things decided." In the U.S. legal system, this Latin phrase represents the "doctrine of precedent, under which a court must follow earlier decisions when the same points arise again in litigation." ( Black's Law Dictionary , 11th ed.) Typically, a court will deviate from precedent only if there is a compelling reason. Under "vertical" stare decisis , the decisions of the highest court in a jurisdiction create mandatory precedent that must be followed by lower courts in that jurisdiction. For example, the U.S. Supreme Court creates binding precedent that all other federal courts must follow (and that all state courts must follow on questions of constitutional interpretation). Similarly, the highest court in a state creates mandatory precedent for the lower state courts below it. Intermediate appellate courts (such as the federal circuit courts of appeal) create mandatory precedent for the courts below them. A related concept is "horizontal" stare decisis , whereby a court applies its own prior decisions to similar facts before it in the future.

Case Law Reporters

Decisions are published in serial print publications called “reporters,” and are also published electronically. Reporters are discussed in greater detail under " Federal Court Decisions " and " State Court Decisions ." Information about how to cite decisions in a reporter is discussed under " Citations ."

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How to Write a Strong Legal Brief Introduction and Closing

Creating a winning brief requires significant attention to detail, research, a thorough understanding of the legal issues involved, flawless formatting , and the ability to think one step ahead of any counter arguments. A well-constructed brief demonstrates your command of the law and makes it easy for the court to follow and adopt your argument.

The sandwich approach to briefing

You can think of a great brief like a great sandwich. Your well laid out argument is the “meat” (or veggies, or whatever you prefer) in the middle, but the initial taste a reader will get is the top slice of bread, and the last taste they’ll get is the bottom slice—so they’d both better not be stale. A compelling brief also requires a strong introduction and closing. Below are some tips and suggestions that will help you write both.

The 5 elements of a compelling legal brief intro

A good legal brief introduction is important, because it sets the stage for the rest of your document. Here are five tips for writing an effective introduction…

1. State the issue : Begin by stating the issue that the brief will address. This should be a clear and concise statement that lets the reader know what your brief is about.

2. Provide contex t: Once you’ve stated the issue, provide some context for it. Explain why the issue is important and how it came to be. This will help the reader understand why the issue is being addressed and what is at stake.

3. Preview your argument : Give the reader a preview of your argument. Briefly summarize the main points that you will be making in the brief. This will help the reader understand the structure of the brief and what they can expect to find in it.

4. Use clear and concise language : It’s important to use clear and precise language in the introduction. Avoid using jargon or arcane terms that some readers may not be as familiar with. Use simple, straightforward language that is easy to understand.

5. Be persuasive : Your intro is your first opportunity to convince the reader that your argument is strong and that you have a compelling case. Use confident, persuasive language and make a clear and compelling case for your position.

Overall, a good introduction should be clear, concise, and persuasive. It should set the stage for the rest of your brief and convince the reader that your argument is strong and compelling.

Build credibility and finish strong with a short conclusion

Keeping a conclusion short is important for a number of reasons, particularly in the legal field where clarity and precision are highly valued. Why?

First, a short conclusion ensures that the reader is able to quickly and easily understand the key takeaways of your brief or argument. Legal writing can often be dense and technical, so a succinct conclusion helps to distill and elevate the most important points in a clear and accessible way.

Second, a short conclusion shows that you have a strong command of the material and are able to summarize complex legal arguments concisely. This can help to build credibility with the reader, whether it be a judge, opposing counsel, or other legal professionals.

Third, a short conclusion can help demonstrate your respect for the reader’s time and attention. Busy legal professionals may not have the luxury of reading through lengthy, meandering conclusions. Getting straight to the point shows that you value the reader’s time and understand that brevity can be just as effective as length.

Finally, a short conclusion can help to reinforce the overall organization and structure of your brief or argument. A clear and concise summary of the key points reminds the reader of the structure and flow of your argument, which will help to strengthen the overall persuasiveness of your brief.

5 Examples of short, effective legal brief conclusions

Briefing is time-consuming, hard work. If you’re feeling stuck about how to end your brief, consider these examples of short conclusions that you can adapt, as needed, to fit your case.

1. “For the reasons discussed above, we respectfully request that the court grant our motion for summary judgment.”

2. “In conclusion, the evidence presented clearly demonstrates that our client is not liable for the plaintiff’s injuries. We urge the court to dismiss this case.”

3. “Based on the foregoing, we ask the court to deny the defendant’s motion to dismiss and allow this case to proceed to trial.”

4. “In summary, the prosecution has failed to meet its burden of proof beyond a reasonable doubt. We ask that the court acquit our client of all charges.”

5. “In light of the legal precedent and the facts of this case, we respectfully request that the court grant our motion to suppress the evidence.”

By keeping your conclusion brief and to the point, you can ensure that the reader understands your key points. You can also demonstrate your command of the material, show respect for the reader’s time, and reinforce the overall organization and structure of your argument.

Writing more persuasive legal briefs

Depending upon the type of law you practice, your workload, the size of your firm, and the nature of your cases, you may file a handful of briefs each year, dozens, or over 100. No matter how often you file, these tips should help you write more compelling briefs by sandwiching your brilliant argument between a strong introduction and conclusion.

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Writing Effective Legal Case Briefs for Law Students

How to write a case brief, complete with examples.

tl;dr - Case briefs help your understanding of legal concepts and enable you to better prepare for exams. Here are some example case briefs .

As a new law student, one of the essential skills you need to develop is the ability to write effective legal case briefs. A case brief is a concise summary of a legal case that highlights the key issues, legal principles, and holdings of the court. Writing a good case brief can help you better understand the law, prepare for class discussions and exams, and become a more effective legal professional. In this article, we'll explore the key elements of a good legal case brief and provide some tips on how to write one effectively.

Legal case briefs are an essential tool for you as a law student, as they provide a concise and organized summary of a court case. Case brief examples serve as a means for you to understand the facts, issues, and legal principles underlying a court decision, and are crucial in helping you develop analytical and critical thinking skills.

One of the primary reasons why case briefs are important for you is that they help you understand the law in a practical and applied manner. In law school, you study legal principles and concepts in a theoretical sense. However, case briefs provide a means for you to see how these principles are applied in real-world situations. By analyzing and dissecting court decisions, you are able to gain a better understanding of how legal principles and concepts are applied in practice. For example, case brief examples of landmark cases like Marbury v. Madison or Brown v. Board of Education can help you understand the historical and legal significance of these cases.

Understand the Structure of a Legal Case Brief

Before we dive into the details of how to write a good legal case brief, it's important to understand its structure. A typical legal case brief, such as the examples of case briefs available on LSD , includes the following sections:

• Title and Citation: This section includes the name of the case, the court that decided the case, and the citation (i.e., the reference that identifies where the case is published).
• Facts: This section provides a brief summary of the key facts of the case, including who the parties are, what they did, and how the case came to court.
• Issues: This section identifies the legal issues that the court was asked to decide, and focuses on the questions that the court addressed in its decision.
• Holding: This section summarizes the court's decision on the legal issues presented in the case.
• Analysis: This section provides an explanation of the court's reasoning in arriving at its holding, including the legal principles and rules that the court relied on.

Focus on the Key Facts and Issues

When writing a case brief, it's important to focus on the key facts and legal issues presented in the case. You should avoid including unnecessary details or information that is not relevant to the legal issues. Instead, focus on the facts and issues that are essential to understanding the court's decision. This is evident in many examples of case briefs written by legal professionals.

Identify the Legal Principles and Rules

In addition to focusing on the key facts and issues, it's important to identify the legal principles and rules that the court relied on in arriving at its decision. This will help you understand the court's reasoning and the legal principles that are relevant to the case. Many examples of case briefs available online also highlight the legal principles and rules that were applied in a particular case.

Use Clear and Concise Language

A good legal case brief should be written in clear and concise language, as seen in examples of case briefs written by legal professionals. You should avoid using legal jargon or technical terms that may be difficult for a layperson to understand. Instead, use plain language that accurately conveys the meaning of the court's decision.

Be Organized and Structured

To make your case brief more effective, it's important to be organized and structured in your writing. Use headings and subheadings to separate different sections of your brief, and make sure that each section flows logically from one to the next. This is evident in many examples of case briefs available online, which are organized and structured in a clear and logical manner.

So, what’s the point?

Developing analytical and critical thinking skills.

Writing case briefs helps you develop analytical and critical thinking skills. By analyzing court decisions and identifying key facts, issues, and legal principles, you are practicing your ability to think critically and to identify relevant legal issues. Case briefs provide a practical way to develop these skills and apply them to real-world legal problems.

To further develop your analytical and critical thinking skills, you can practice writing your own case briefs. Take a recent court decision and write a brief that summarizes the key facts, issues, and legal principles involved. This will help you become more proficient at identifying relevant information and organizing it in a structured manner.

Preparing for Class and Exams

In addition to being a valuable tool for developing analytical skills, case briefs also help you prepare for class discussions and exams. As you read cases and write briefs, you are gaining a deeper understanding of the law and the reasoning behind court decisions. This knowledge will help you participate more effectively in class discussions and will also help you prepare for law school exams.

To get the most out of case briefs when preparing for exams, you can practice writing case briefs for cases that you studied throughout the year, or to hypotheticals from past exams. This will help you apply the analytical skills you've developed to new situations and ensure that you are able to communicate your understanding of legal principles effectively.

In conclusion, case briefs are an essential tool for law students as they provide a practical application of legal principles, help develop analytical and critical thinking skills, and aid in preparing for class discussions and exams. By studying case brief examples, practicing writing your own briefs, and developing a deep understanding of the law in context, you can become a more proficient and effective student and legal professional. For examples, check out LSD's case brief database .

Tech-focused creator of LSD.Law. I built LSD while applying to law school. I saw unequal access to knowledge and built LSD to level the playing field and help applicants make thoughtful, well-informed decisions in the application process.

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Legal Research & Writing Guide

• Legal Abbreviations
• Shepard's Citations
• Citation Examples
• How to Find State Statutes
• The U.S. Supreme Court
• Constitutional Law

How to Read a Case

How to brief a case, recommended videos.

• Case Page Numbering
• Using Nexis Uni Citation Tools

Research Help

Need further assistance email us or make an appointment., email: [email protected], helpful youtube channels.

The following online resources offer guidance for reading case law and court decisions.

• How to Read a Court Decision This guide from Roosevelt University describes the different parts of a court decision.
• LexisNexis: How to Read a Law School Casebook Features an excerpt from Guide to the Study of Law: An Introduction, 2nd ed. (LexisNexis 2001) by L.H. LaRue.

The following online resources provide useful tips for writing case briefs and outlines.

• How to Brief a Case Features an excerpt from "How to Study Law and Take Law Exams in a Nutshell" with a step-by-step guide to briefing cases
• LexisNexis: How to Write a Case Brief Features an excerpt reproduced from Introduction to the Study of Law: Cases and Materials.
• Case Briefing: The Law School Playbook
• Case Reading: The Law School Playbook
• Introduction to Cases / Anatomy of a Case
• How To Write A Case Brief or Case Outline for Law School (With An Example)
• How to Read a Case: And Understand What it Means

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• Next: Case Page Numbering >>
• Last Updated: Sep 13, 2023 1:34 PM
• URL: https://egcc.libguides.com/legal-research

Introduction to Legal Research

Introduction

• Legislative Branch (statutory law)

The Judicial Process

Federal court system, finding a case, finding a case: annotated codes, finding a case: digests, find a case: legal encyclopedias, additional places to access federal case law, case reporters, reading a case citation, additional guides.

• Executive Branch (administrative law)
• Secondary Sources
• Georgia Law

Case Law and Its Authority

Case law is the collection of reported cases that form the body of law withing a given jurisdiction.  It is based upon judicial opinions by various courts, which may set future precedent.

Courts in the United States adhere to stare decisis , which generally means that courts respect and adhere to the precedent of previous decisions.  However, a court does not have to stand by a decision that is not binding precedent.  Generally courts will follow the decisions of higher courts in their jurisdiction.  Therefore the effect of a court's decision on other courts will depend both on the level of the court and its jurisdiction.  A decision by the United States Supreme Court is binding precedent in all courts. 

A decision by the United States Court of Appeals for the 11th Circuit would not be binding on the United States Supreme Court or courts from another circuit.  However, it would be binding in all lower courts of the 11th Circuit.

Publication of Case Law

Not all case law is published.  Generally, appellate court decisions that will be used as future precedent are published (reported) in sources (case reporters) specific to that court.  Attorneys use published case law as a means to interpret the law.  For these reasons, few trial court decisions are published in case reporters.

A case starts at the trial court level, which could either be a trial by judge or trial by jury.  Generally, evidence and witnesses are presented at the trial court level.

An appellate court will hear appeals from parties seeking to change the result of the case heard at the trial court.  An appellate court will not answer questions of fact, meaning they will not review the evidence in a case.  Instead, the appellate court rules on questions of law, which means it considers legal issues.  

Because of the parallel system between state courts and federal courts, researching case law can be difficult and complex.  A researcher will often need to determine if their issue is one that is inherently federal or state.  Even then, some issues can overlap each other and require a state and federal analysis. 

The federal court system is made up of the following courts, excluding the specialized courts: 

The following link provides a map and additional information on the 11 circuits, the federal circuit, and the Supreme Court.

A researcher will not always have a case citation when they begin their research.  Often times a researcher will have an issue or topic that are looking for case law on.  Without a case citation, a researcher would have a daunting challenge trying to go straight to a case reporter and locate a case on their topic.  However, there are several avenues that a researcher can go down if they do not have a citation for a case.

Here are a few suggestions when looking for case law without a citation:

• Annotated Codes (statutes): annotated codes such as the United States Code Annotated (West) or the United States Code Service (LexisNexis) provide researchers with citations to case law. 
• Digests: provide an indexing function for cases in the National Reporter system.  
• Legal Encylopedias: cover a wide range of topics that are arranged alphabetically.  Many of the topics include footnotes with citations to relevant case law.     
• LexisNexis Academic: research system that allows users to search for cases by party name, case citation, or by keyword searches. 

Each of these methods are described in more detail in the boxes that follow.

Annotated codes produced by West and LexisNexis are a great way to find cases on a particular topic.  As mentioned on the Legislative tab , not every law is statutory law, therefore this would not be a good place to find cases where the underlying law is not rooted in statutory law.  However, for issues that do invoke statutory law, the annotated codes are an efficient way to find cases that have cited that particular statute.

Both the United States Code Annotated and the United States Code Service provide case citations after the text of the statute.  The cases will be grouped together by topic and they will often include a short summary.  This provides the researcher with an easier method of locating case law that deals with their particular issue.

For more information on finding a statute in an annotated code, please refer back to the  Legislative tab .  

West's Digests provide an indexing function for the cases in the National Reporter System.  The digests allow researchers to locate cases by subject from any jurisdiction.  In addition, the digests provide an abstracting function, giving researchers short summaries of the points of law discussed in the indexed opinions.  This enables researchers to determine if a case would be worth further exploring without having to read the entire case.   

The Digest System sub-divides the law into over 450 Topics , which are broad legal issues, and then further sub-divided into Key Numbers , which are assigned to specific legal issues within the broader issue.  Topics and Key Numbers are consistent throughout West's System - the same subject arrangement is applied to all cases from every jurisdiction, so that if you find a case from one jurisdiction that discusses a legal issue you are researching, you can use the topic and key number for that isssue to find other cases from other jurisdictions that discuss the same issue.  Remember that you need to know both the topic AND the key number to search the digests.

Currently, the GSU College of Law Library has West's Federal Practice Digest in its collection.  There are two ways that one can search the federal practice digest:

• Table of Cases:   The table of cases lists all of the cases indexed in the digest in alphabetical order.  In addition to the case name and citation, the table of cases also provides the Topics and Key Numbers that apply to that particular case.  This is a great way for a researcher to find the citation for their case if they have the name of the case.  Additionally, this is also a great way to see all of the Topics and Key Numbers that apply to a particular case.  This may lead to futher investigation of those Topics and Key Numbers, which could produce additional cases on the issue for the researcher.
• Desciptive Word Index: The descriptive word index allows researchers to search by topics and subtopics.  A researcher may start with a broad topic and then narrow down the topic to a subtopic.  A subtopic will either provide the appropriate Topic and Key Number where one can find that topic, or it will refer the researcher to another topic.  The index also includes a table at the beginning which lists the topics in order and their abbreviations used in the index.

Here is the typical process of using the descriptive word index to find a case along with an example: 

• A user who is doing research on "abduction" would first go to the Descriptive Word Index. The index is usually several volumes of the digest, generally located near the end of the set of books. Looking under "abduction," one would find several subtopics. If one was only concerned with the criminal liability involved in abduction, they they would look at "CRIMINAL liability" under the term "ABDUCTION." Criminal liability provides the user with the Topic and Key Number Crim Law 45.10 .
• The front of each index provides the researcher with a list of digest topics and what the abbreviations mean.  In the case of our example, Crim Law would mean topic Criminal Law.  Topics are in order alphabetically in the digest.  Therefore, to locate Criminal Law, one would need to just look on the spine of the book until the come to the appropriate volume.  
• Once at the appropriate volume and topic, the researcher can flip to Key Number 45.10.  Key numbers will be in chronological order in each topic.  Once at the correct key number, the researcher will see lists of cases with ciatations and short summaries of those cases.  If the case appears to be on point with what the researcher is looking for, then they can take down the case citation and retrieve that case from the appropriate reporter.

Legal encyclopedias are another great way to find case citations on topics.  Generally, a legal encyclopedia is arranged alphabetically by topic, which are further divded into more detailed subtopics.  Legal encyclopedias provide broad coverage of American state and federal law, including excerpts from judicial decisions and statutes.

For researching federal law, the two most popluar legal encyclopedias are American Jurisprudence (AmJur) and Corpus Juris Secundum (CJS).  Both of these publications provide researchers with a summary of the state of the law along with references to West's Topic and Key Numbers. 

Methods for Searching

Researchers can search for their issue in AmJur and CJS using the General Index.  Similiar to other indexes, the General Index is organized alphabetically by topic, with each topic divided into subtopics.  Citations are provided in Topic and Section format.  An abbreviations table is provided at the front of each volume of the general index to aid researchers in identifying topic names in the index.  Similiar to digets, once a researcher has the topic name and section number for their specific subtopic, they can browse the spine of the books and look for the topic name.  Once at the correct topic name, they can then look for the appropriate section number.  Sections are listed in chronological order. 

In addition to the General Index, AmJur also includes a volume entitled "Table of Laws and Rules."  This volume has several tables which provide cross references from United States Code Annotated sections and Code of Federal Regulations sections to topics and sections in AmJur.  This enables researchers to find articles citing those particular laws and regulations, which could lead to further case citations. 

Printed Reporters and LexisNexis Academic are not the only places researchers can access case law.  Many websites are devoted to providing free access to case law.  Although not comprehensive, many of these websites do offer a good amount of case law if someone knows what they are looking for.  

• Justia Justia provides legal information on numerous legal topics and jurisdictions, including federal and state case law.
• Legal Information Institute at Cornell Law The "Federal Law" section provides users with links to all of the Federal Courts' pages which provide court decisions. Although not comprehensive, many of these pages do provide case law from at least the mid-1990's. This is a good source of free case law.
• Oyez The Oyez Project is a multimedia archive devoted to the Supreme Court of the United States and its work. It aims to be a complete and authoritative source for all audio recorded in the Court since the installation of a recording system in October 1955. The Project also provides authoritative information on all justices and offers a virtual reality 'tour' of portions of the Supreme Court building, including the chambers of some of the justices.
• FindLaw Contains links for both state and federal cases. Opinions are categorized by jurisdiction.

Cases are published in chronological order in books called reporters .  Below is a list of the reporters for the three levels of federal courts:

Some reporters only include cases from a specific court.  For example, the United States Reports only publishes opinions from the Supreme Court of the United States.  On the other hand, some reporters includes cases from courts within a specific geographical region, also known as regional reporters.  For example, the South Eastern Reporter publishes reported cases from the southeastern United States, such as Georgia and North Carolina.  Moreover, some reporters only publish cases on a specific topic, such as bankruptcy or tax. 

In addition to these designations, reporters are also classified as official or unofficial reporters.  An official reporter simply means that it is the publication designated by statute or court order as official.  Generally it will contain only the text of the opinion.  A case published in an unofficial reporter will include the same text of the same case from the official reporter, but it will also include headnotes, topics, key numbers, and other aids to assist researchers.

Parallel Citations

As mentioned above, a case can be published in an official reporter and an unofficial reporter.  For that reason, a single case may have 2 or more citations.  When a case has more than one citation, the subsequent citations are known as parallell citations.  A classic example of this is Bush v. Gore , 531 U.S. 98, 121 S. Ct. 525, 148 L. Ed. 2d 388 (2000).

As one can see, not only is Bush v. Gore cited in the official reporter ( United States Reports ), but also in two unofficial reporters ( Supreme Court Reporter and Lawyer's Edition . 

Case citations allow a researcher to find a case quickly and easily.  Similiar to statutory citations, all case citations follow the same structured format.  This enables researchers to clearly identify the parts of a citation and where to locate the case.

Here is a breakdown of the citation for Roe v. Wade, 410 U.S. 113 (1973).

From this, a researcher can determine that the case Roe v. Wade is located in United States Reports , Volume 410, Page 113.

The process is the same with parallel citations.  So if we use the previous example of Bush v. Gore , 531 U.S. 98, 121 S. Ct. 525, 148 L. Ed. 2d 388 (2000), the breakdown would look something like this:

Thus, a researcher would be able to either of these 3 reporters and find the same case using that reporter's volume and page numbers.  

Pinpoint Cite

A researcher may also come across a citation that includes an additional number after the page number.  This additional number, numbers or range of numbers are called pinpoint cites.  Cases and articles will often use these to refer researchers to exactly where the thought arose from.  Here is an example using  Bush v. Gore , 531 U.S. 98 (2000).

Federal Reporter Citation

Cases cited to Federal Reporter will have an extra element in the citation to identify the court.  Unlike the United States Reports, Supreme Court Reporter, and Lawyer's Edition, which only publishes cases from the Supreme Court of the United States, the Federal Reporter publishes cases from several different courts.  Therefore, cases published in these reporters include an element in the parentheses to identify the court that rendered the decision. 

Here is an example using United States v. MacDonald , 531 F.2d 196 (4th Cir. 1976).

In this case, the deciding court is 4th Cir. which means United States Court of Appeals, 4th Circuit.

Each circuit court will have its own abbreviation which will help the researcher identify the court that rendered the decision.  This is important for researchers because they might only want to find cases from their jurisdiction.  

Here is a table circuits and their abbreviations used in case citations for the United States Court of Appeals:

Federal Supplement Citation

Similar to the Federal Reporter , cases cited to the Federal Supplemen t will also include an extra element in the citation.  Cases cited to the Federal Supplement are United States District Court decisions.  Therefore, an extra element will be included in these citations so that a researcher can determine which court rendered the decision.  

Here is an example using Jenkins v. Byrd , 103 F. Supp. 2d 1350 (S.D. Ga. 2000).

In this case, the deciding court was the S.D. Ga, which means the United States District Court,Southern District of Georgia.

Because there could be several United States District Courts inside one state, a researcher unfamiliar with a state may need to look up the court abbreviation to determine which court is referenced in the citation.  

Here is a brief list of some abbreviations for United States District Courts that might be most useful for researchers in Georgia: 

For additional district court abbreviations, please refer to George Butterfield's libguide titled Legal Abbreviations.  

Here are some research guides created by other law schools that might be helpful in explaining how to conduct case law legal research.

• Boston University School of Law Federal Case Law Research
• Georgetown University Law Center Case Law Research Guide
• Georgetown University Law Center Case Law Research Tutorial
• University of Washington School of Law Case Law Research Checklist
• University of Washington School of Law Case Law Research
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• Last Updated: Feb 29, 2024 11:02 AM
• URL: https://libguides.law.gsu.edu/intro

Organizing Your Social Sciences Research Paper: Writing a Case Study

• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Choosing a Title
• Making an Outline
• Paragraph Development
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Reading Research Effectively
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• What Is Scholarly vs. Popular?
• Qualitative Methods
• Quantitative Methods
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Annotated Bibliography
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Multiple Book Review Essay
• Reviewing Collected Essays
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Research Proposal
• Bibliography

The term case study refers to both a method of analysis and a specific research design for examining a problem, both of which are used in most circumstances to generalize across populations. This tab focuses on the latter--how to design and organize a research paper in the social sciences that analyzes a specific case.

A case study research paper examines a person, place, event, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or among more than two subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies . Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in this writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a single case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

• Does the case represent an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
• Does the case provide important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
• Does the case challenge and offer a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in practice. A case may offer you an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to the study a case in order to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
• Does the case provide an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings in order to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
• Does the case offer a new direction in future research? A case study can be used as a tool for exploratory research that points to a need for further examination of the research problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of Uganda. A case study of how women contribute to saving water in a particular village can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community throughout rural regions of east Africa. The case could also point to the need for scholars to apply feminist theories of work and family to the issue of water conservation.

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work. In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

• What was I studying? Describe the research problem and describe the subject of analysis you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
• Why was this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
• What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the research problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
• How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

• Place relevant works in the context of their contribution to understanding the case study being investigated . This would include summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
• Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to study the research problem and the underlying research questions.
• Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
• Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
• Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
• Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
• Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in the context of explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular subject of analysis to study and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that frames your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; c) what were the consequences of the event.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experience he or she has had that provides an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of his/her experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using him or her as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem.

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, cultural, economic, political, etc.], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, why study Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research reveals Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut? How might knowing the suppliers of these trucks from overseas reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should be linked to the findings from the literature review. Be sure to cite any prior studies that helped you determine that the case you chose was appropriate for investigating the research problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is more common to combine a description of the findings with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps to support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings It is important to remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations for the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and needs for further research.

The function of your paper's conclusion is to: 1)  restate the main argument supported by the findings from the analysis of your case; 2) clearly state the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place for you to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

• If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
• If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in and your professor's preferences, the concluding paragraph may contain your final reflections on the evidence presented applied to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were on social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood differently than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis.

Case Studies . Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent knowledge is more valuable than concrete, practical (context-dependent) knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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First Year Tip Series: Introduction to Case Notes

Ben conlon, senior editorial board (online editor).

A case note is something that every law student is asked to write at some point in their studies and, without some direction, can be a daunting task. This article aims to briefly explain what a case note is, what the benefits of writing a case note are, and how to actually write a case note. Further information is also included at the end of the piece about the Gernot Biehler Case Note competition.

What is a Case Note?

A case note is a summary and analysis of a single case, as opposed to an article, which examines an area of law. A case note should outline the facts of the case, as well as its ratio decedendi , and also provide a critical analysis of the decision. The analysis should concern the correctness of the decision, with reference to case law, accepted logic and academic opinion. A good case note usually contains analysis of the effect that the decision may have on future cases, especially if the decision is a departure from a previously settled point of law.

What to Keep in Mind when Selecting a Case

If you have the option of selecting the case you would like to write on, below are some factors you should keep in mind:

• Try to pick an area of significant concern or a topical issue
• Does the case seem to ignore reason/common sense?
• Is there a recent case where the court departs from precedent or a position accepted in other jurisdictions?
• Does the decision which may have significant extra-legal repercussions.
• Will this decision prompt interesting results in future cases?
• Was this the first case in a newly-legislated area?
• Has there already been substantial academic commentary written on this case? Often it may be better, for originality’s sake to write on a new case, or one that has not been subject to as much discussion.

How to Write a Case Note

(A) Research

As with any piece of legal writing, the first step in writing a case note is conducting the necessary research. Read the case multiple times and note down the facts and the ratio decedendi . The case should be read in the context of the area of law as a whole; understanding how the case relates to existing principles and case law is key in forming a critique and analysis. Further consideration should be given to whether the law is still relevant, and whether it is still considered to be a strong precedent. While a case note tends not to rely on academic sources as much as a legal essay, it is still worth exploring academic commentary around the case, from which a greater perspective can be gleaned.

(B) Writing

There is no rigid structure for how a case note should be written, but this article will attempt to lay out a basic structure and guide for writing the case note itself. It is worth noting that many brilliant case notes do not follow this structure, and can often depart from it dramatically, so there is no pressure to follow this structure.

As is the case in most legal writing, it is generally recommended that the piece is broken down into separate headings. This can make the case note easier to follow, and direct the reader to the important elements of the piece. When writing a case note for a legal journal or a university assignment, regard should be had for the word-count when deciding on how specific the headings are; if there is a lower word-count, it might make sense to merge some of the headings together.

(i) The Introduction

The introduction of a case note should introduce the case and indicate the court in which it was decided. It should lay out the structure of the case note, explain the significance of the case (i.e. the change in the law brought about by the case), and briefly outline your opinion of the case.

(ii) The Facts of the Case

The second section of the case note should briefly outline the facts of the case. It is important to keep in mind that a case note is not simply a summary of a case; the facts simply set out the background for your analysis. Due to this, this section of the case note should not be too long, and the aim should be to illustrate the facts that were relevant in the court’s reasoning, rather than the entirety of the factual circumstances. This is generally a good place to mention the decisions of the lower courts in relation to the case at hand.

(iii) The Decision and the Ratio Decidendi

This section of the case note should deal with the reasoning that lead to the court’s decision, and specific emphasis should be placed on the key decisions and the ratio decedendi . Here, detail should be provided on the case law that the court either relied on or moved away from, and a short explanation of the reasoning behind such moves should be given. The way that the decision was handled should also be mentioned (e.g. was the judgment suspended to allow the government to amend the issue?), as this is often indicative of the attitude of the courts in relation to the issue at hand.

(iv) Critical Analysis/Further Discussion

The primary aim of a case note is to critically analyse a particular decision and the effect it has on the law. “Critically analyse” can be a confusing phrase, so considering some of the following questions may be a useful starting point:

• Is the logic of the judgment sound? Do you agree with it? Why or why not?
• Does the judgment differ or depart from previous decisions? Does it follow some aspects but not others?
• How does the judgment compare with international precedent?
• Does the judgment reflect political/economic/cultural tensions?
• Does the judgment fail to acknowledge any legal or extralegal repercussions it may have?
• Has the judgment failed to address any important questions?
• Do you agree with the decision? Why?

It is worth noting that “critically analyse” does not mean you have to disagree with a judgment; the best critical analysis praises some aspects of a judgment, and attacks others. Commentary on previous related decisions may help to inform your opinion on a case, and help with the critical analysis. It is recommended that some thought is given to how the case may have a lasting impact, and it should be acknowledged whether or not the case might be open to appeal. However, as in any legal piece, it is advisable that a certain degree of critical analysis is woven throughout the piece, rather than isolated to one section.

(v) Conclusion

The conclusion should very briefly summarise the decision, the flaws and achievements that have been discussed throughout the case note, and your overall opinion. A general rule for any piece of writing is that new substantive arguments that have not been discussed in the body of the piece should not be introduced in the conclusion. Finally, some concluding remarks could be offered about the effect of the case on that area of law, and how future cases may be influenced by it.

Some Final Tips

As is the case with any piece of legal writing, there should be a cohesive thread of argument that runs through the case note, but this may be difficult to  pick up on  after several hours of writing by yourself.  As a result, the argument you have crafted might make sense to you, but not to a new reader. One of the best ways to deal with this is to ask someone else to read over the piece and offer some of their own comments.

While it is always advised to read through previous academic pieces written on your chosen area, make sure when citing academics that you are also evaluating their arguments to the reader. Do you agree with what the academic has said? How does their argument bolster yours? Or, how would you refute what the academic has argued? Analysing the academic commentary you have utilised is key to presenting critical analysis in your piece.

In the same vein, when presenting your arguments, it is recommended that you recognise ‘the other side.’ This is particularly important in controversial areas of law, like socio-economic rights, where presenting a one-sided argument will reflect poorly on the author’s critical analysis.

As a final note, the TCLR Online has published many case notes, and reading over these can help you to form a picture of what a case note looks like, and what a case note should contain. Many longer case notes have also been published in the print version of the TCLR, which can be found on the legal article database Heinonline.

The Gernot Biehler Case Note Competition

The Trinity College Law Review runs an annual case note competition in honour of Dr. Gernot Biehler. Dr. Biehler was a distinguished fellow of Trinity College and a lecturer in international law and conflicts of law, who died aged 48. Dr. Biehler was a keen supporter of the work of the Law Review.

The competition is open to first and second year undergraduate students from all universities. Case notes are subject to a word limit of 3,000 words excluding footnotes, and the deadline for submitting your entry is the 17th January 2020. The winning entry is published in the print journal of the Trinity College Law Review, and the winner receives a cash prize of €250. More information on the competition can be found at www.trinitycollegelawreview.org/submissions/ .

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O'Mathúna D, Iphofen R, editors. Ethics, Integrity and Policymaking: The Value of the Case Study [Internet]. Cham (CH): Springer; 2022. doi: 10.1007/978-3-031-15746-2_1

Ethics, Integrity and Policymaking: The Value of the Case Study [Internet].

Chapter 1 making a case for the case: an introduction.

Dónal O’Mathúna and Ron Iphofen .

Affiliations

Published online: November 3, 2022.

This chapter agues for the importance of case studies in generating evidence to guide and/or support policymaking across a variety of fields. Case studies can offer the kind of depth and detail vital to the nuances of context, which may be important in securing effective policies that take account of influences not easily identified in more generalised studies. Case studies can be written in a variety of ways which are overviewed in this chapter, and can also be written with different purposes in mind. At the same time, case studies have limitations, particularly when evidence of causation is sought. Understanding these can help to ensure that case studies are appropriately used to assist in policymaking. This chapter also provides an overview of the types of case studies found in the rest of this volume, and briefly summarises the themes and topics addressed in each of the other chapters.

1.1. Judging the Ethics of Research

When asked to judge the ethical issues involved in research or any evidence-gathering activity, any research ethicist worth their salt will (or should) reply, at least initially: ‘It depends’. This is neither sophistry nor evasive legalism. Instead, it is a specific form of casuistry used in ethics in which general ethical principles are applied to the specifics of actual cases and inferences made through analogy. It is valued as a structured yet flexible approach to real-world ethical challenges. Case study methods recognise the complexities of depth and detail involved in assessing research activities. Another way of putting this is to say: ‘Don’t ask me to make a judgement about a piece of research until I have the details of the project and the context in which it will or did take place.’ Understanding and fully explicating a context is vital as far as ethical research (and evidence-gathering) is concerned, along with taking account of the complex interrelationship between context and method (Miller and Dingwall 1997 ).

This rationale lies behind this collection of case studies which is one outcome from the EU-funded PRO-RES Project. 1 One aim of this project was to establish the virtues, values, principles and standards most commonly held as supportive of ethical practice by researchers, scientists and evidence-generators and users. The project team conducted desk research, workshops and consulted throughout the project with a wide range of stakeholders (PRO-RES 2021a ). The resulting Scientific, Trustworthy, and Ethical evidence for Policy (STEP) ACCORD was devised, which all stakeholders could sign up to and endorse in the interests of ensuring any policies which are the outcome of research findings are based upon ethical evidence (PRO-RES 2021b ).

By ‘ethical evidence’ we mean results and findings that have been generated by research and other activities during which the standards of research ethics and integrity have been upheld (Iphofen and O’Mathúna 2022 ). The first statement of the STEP ACCORD is that policy should be evidence-based, meaning that it is underpinned by high-quality research, analysis and evidence (PRO-RES 2021b ). While our topic could be said to be research ethics, we have chosen to refer more broadly to evidence-generating activities. Much debate has occurred over the precise definition of research under the apparent assumption that ‘non-research projects’ fall outside the purview of requirements to obtain ethics approval from an ethics review body. This debate is more about the regulation of research than the ethics of research and has contributed to an unbalanced approach to the ethics of research (O’Mathúna 2018 ). Research and evidence-generating activities raise many ethical concerns, some similar and some distinct. When the focus is primarily on which projects need to obtain what sort of ethics approval from which type of committee, the ethical issues raised by those activities themselves can receive insufficient attention. This can leave everyone involved with these activities either struggling to figure out how to manage complex and challenging ethical dilemmas or pushing ahead with those activities confident that their approval letter means they have fulfilled all their ethical responsibilities. Unfortunately, this can lead to a view that research ethics is an impediment and burden that must be overcome so that the important work in the research itself can get going.

The alternative perspective advocated by PRO-RES, and the authors of the chapters in this volume, is that ethics underpins all phases of research, from when the idea for a project is conceived, all the way through its design and implementation, and on to how its findings are disseminated and put into practice in individual decisions or in policy. Given the range of activities involved in all these phases, multiple types of ethical issues can arise. Each occurs in its own context of time and place, and this must be taken into account. While ethical principles and theories have important contributions to make at each of these points, case studies are also very important. These allow for the normative effects of various assumptions and declarations to be judged in context. We therefore asked the authors of this volume’s chapters to identify various case studies which would demonstrate the ethical challenges entailed in various types of research and evidence-generating activities. These illustrative case studies explore various innovative topics and fields that raise challenges requiring ethical reflection and careful policymaking responses. The cases highlight diverse ethical issues and provide lessons for the various options available for policymaking (see Sect.  1.6 . below). Cases are drawn from many fields, including artificial intelligence, space science, energy, data protection, professional research practice and pandemic planning. The issues are examined in different locations, including Europe, India, Africa and in global contexts. Each case is examined in detail and also helps to anticipate lessons that could be learned and applied in other situations where ethical evidence is needed to inform evidence-based policymaking.

1.2. The Case for Cases

Case studies have increasingly been used, particularly in social science (Exworthy and Powell 2012 ). Many reasons underlie this trend, one being the movement towards evidence-based practice. Case studies provide a methodology by which a detailed study can be conducted of a social unit, whether that unit is a person, an organization, a policy or a larger group or system (Exworthy and Powell 2012 ). The case study is amenable to various methodologies, mostly qualitative, which allow investigations via documentary analyses, interviews, focus groups, observations, and more.

At the same time, consensus is lacking over the precise nature of a case study. Various definitions have been offered, but Yin ( 2017 ) provides a widely cited definition with two parts. One is that a case study is an in-depth inquiry into a real-life phenomenon where the context is highly pertinent. The second part of Yin’s definition addresses the many variables involved in the case, the multiple sources of evidence explored, and the inclusion of theoretical propositions to guide the analysis. While Yin’s emphasis is on the case study as a research method, he identifies important elements of broader relevance that point to the particular value of the case study for examining ethical issues.

Other definitions of case studies emphasize their story or narrative aspects (Gwee 2018 ). These stories frequently highlight a dilemma in contextually rich ways, with an emphasis on how decisions can be or need to be made. Case studies are particularly helpful with ethical issues to provide crucial context and explore (and evaluate) how ethical decisions have been made or need to be made. Classic cases include the Tuskegee public health syphilis study, the Henrietta Lacks human cell line case, the Milgram and Zimbardo psychology cases, the Tea Room Trade case, and the Belfast Project in oral history research (examined here in Chap. 10 ). Cases exemplify core ethical principles, and how they were applied or misapplied; in addition, they examine how policies have worked well or not (Chaps. 2 , 3 and 5 ). Cases can examine ethics in long-standing issues (like research misconduct (Chap. 7 ), energy production (Chap. 8 ), or Chap. 11 ’s consideration of researchers breaking the law), or with innovations in need of further ethical reflection because of their novelty (like extended space flight (Chap. 9 ) and AI (Chaps. 13 and 14 ), with the latter looking at automation in legal systems). These case studies help to situate the innovations within the context of widely regarded ethical principles and theories, and allow comparisons to be made with other technologies or practices where ethical positions have been developed. In doing so, these case studies offer pointers and suggestions for policymakers given that they are the ones who will develop applicable policies.

1.3. Research Design and Causal Inference

Not everyone is convinced of the value of the case study. It must be admitted that they have limitations, which we will reflect on shortly. Yet we believe that others go too far in their criticisms, revealing instead some prejudices against the value of the case (Yin 2017 ). In what has become a classic text for research design, Campbell and Stanley ( 1963 ) have few good words for what they call the ‘One Shot Case Study.’ They rank it below two other ‘pre-experimental’ designs—the One-Group Pretest–Posttest and the Static-Group Comparison—and conclude that case studies “have such a total absence of control to be of almost no scientific value” (Campbell and Stanley 1963 , 6). The other designs have, in turn, a baseline and outcome measure and some degree of comparative analysis which provides them some validity. Such a criticism is legitimate if one prioritises the experimental method as the most superior in terms of effectiveness evidence and, as for Campbell and Stanley, one is striving to assess the effectiveness of educational interventions.

What is missing from that assessment is that different methodologies are more appropriate for different kinds of questions. Questions of causation and whether a particular treatment, policy or educational strategy is more effective than another are best answered by experimental methods. While experimental designs are better suited to explore causal relationships, case studies are more suited to explore “how” and “why” questions (Yin 2017 ). It can be more productive to view different methodologies as complementing one another, rather than examining them in hierarchical terms.

The case study approach draws on a long tradition in ethnography and anthropology: “It stresses the importance of holistic perspectives and so has more of a ‘humanistic’ emphasis. It recognises that there are multiple influences on any single individual or group and that most other methods neglect the thorough understanding of this range of influences. They usually focus on a chosen variable or variables which are tested in terms of their influence. A case study tends to make no initial assumptions about which are the key variables—preferring to allow the case to ‘speak for itself’” (Iphofen et al. 2009 , 275). This tradition has sometimes discouraged people from conducting or using case studies on the assumption that they take massive amounts of time and lead to huge reports. This is the case with ethnography, but the case study method can be applied in more limited settings and can lead to high-quality, concise reports.

Another criticism of case studies is that they cannot be used to make generalizations. Certainly, there are limits to their generalisability, but the same is true of experimental studies. One randomized controlled trial cannot be generalised to the whole population without ensuring that its details are evaluated in the context of how it was conducted.

Similarly, it should not be assumed that generalisability can adequately guide practice or policy when it comes to the specifics of an individual case. A case study should not be used to support statistical generalizations (that the same percentage found in the case will be found in the general public). But a case study can be used to expand and generalize theories and thus have much usefulness. It affords a method of examining the specific (complex) interactions occurring in a case which can only be known from the details. Such an analysis can be carried out for individuals, policies or interventions.

The current COVID-19 pandemic demonstrates the dangers of generalising in the wrong context. Some people have very mild cases of COVID-19 or are asymptomatic. Others get seriously ill and even die. Sometimes people generalise from cases they know and assume they will have mild symptoms. Then they refuse to take the COVID-19 vaccine, basically generalising from similar cases. Mass vaccination is recommended for the sake of the health of the public (generalised health) and to limit the spread of a deadly virus. Cases are reported of people having adverse reactions to COVID-19 vaccines, and some people generalise from these that they will not take whatever risks might be involved in receiving the vaccine themselves. It might be theoretically possible to discover which individuals WILL react adversely to immunisation on a population level. But it is highly complex and expensive to do so, and takes an extensive period of time. Given the urgency of benefitting the health of ‘the public’, policymakers have decided that the risks to a sub-group are warranted. Only after the emergence of epidemiological data disclosing negative effects of some vaccines on some individuals will it become more clear which characteristics typify those cases which are likely to experience the adverse effects, and more accurately quantify the risks of experiencing those effects.

Much literature now points to the advantages and disadvantages of case studies (Gomm et al. 2000 ), and how to use them and conduct them with adequate rigour to ensure the validity of the evidence generated (Schell 1992 ; Yin 2011 , 2017 ). At the same time, legitimate critiques have been made of some case studies because they have been conducted without adequate rigor, in unsystematic ways, or in ways that allowed bias to have more influence than evidence (Hammersley 2001 ). Part of the problem here is similar to interviewing, where some will assume that since interviews are a form of conversation, anyone can do it. Case studies have some similarities to stories, but that doesn’t mean they are quick and easy ways to report on events. That view can lead to the situation where “most people feel that they can prepare a case study, and nearly all of us believe we can understand one. Since neither view is well founded, the case study receives a lot of approbation it does not deserve” (Hoaglin et al., cited in Yin 2017 , 16).

Case studies can be conducted and used in a wide range of ways (Gwee 2018 ). Case studies can be used as a research method, as a teaching tool, as a way of recording events so that learning can be applied to practice, and to facilitate practical problem-solving skills (Luck et al. 2006 ). Significant differences exist between a case study that was developed and used in research compared to one used for teaching (Yin 2017 ). A valid rationale for studying a ‘case’ should be provided so that it is clear that the proposed method is suitable to the topic and subject being studied. The unit of study for a case could be an individual person, social group, community, or society. Sometimes that specific case alone will constitute the actual research project. Thus, the study could be of one individual’s experience, with insights and understanding gained of the individual’s situation which could be of use to understand others’ experiences. Often there will be attempts made at a comparison between cases—one organisation being compared to another, with both being studied in some detail, and in terms of the same or similar criteria. Given this variety, it is important to use cases in ways appropriate to how they were generated.

The case study continues to be an important piece of evidence in clinical decision-making in medicine and healthcare. Here, case studies do not demonstrate causation or effectiveness, but are used as an important step in understanding the experiences of patients, particularly with a new or confusing set of symptoms. This was clearly seen as clinicians published case studies describing a new respiratory infection which the world now knows to be COVID-19. Only as case studies were generated, and the patterns brought together in larger collections of cases, did the characteristics of the illness come to inform those seeking to diagnose at the bedside (Borges do Nascimento et al. 2020 ). Indeed case studies are frequently favoured in nursing, healthcare and social work research where professional missions require a focus on the care of the individual and where cases facilitate making use of the range of research paradigms (Galatzer-Levy et al. 2000 ; Mattaini 1996 ; Gray 1998 ; Luck et al. 2006 ).

1.4. Devil’s in the Detail

Our main concern in this collection is not with case study aetiology but rather to draw on the advantages of the method to highlight key ethical issues related to the use of evidence in influencing policy. Thus, we make no claim to causal ‘generalisation’ on the basis of these reports—but instead we seek to help elucidate ethics issues, if even theoretical, and anticipate responses and obstacles in similar situations and contexts that might help decision-making in novel circumstances. A key strength of case studies is their capacity to connect abstract theoretical concepts to the complex realities of practice and the real world (Luck et al. 2006 ). Ethics cases clearly fit this description and allow the contextual details of issues and dilemmas to be included in discussions of how ethical principles apply as policy is being developed.

Since cases are highly focussed on the specifics of the situation, more time can be given over to data gathering which may be of both qualitative and quantitative natures. Given the many variables involved in the ‘real life’ setting, increased methodological flexibility is required (Yin 2017 ). This means seeking to maximise the data sources—such as archives (personal and public), records (such as personal diaries), observations (participant and covert) and interviews (face-to-face and online)—and revisiting all sources when necessary and as case participants and time allows.

1.5. Cases and Policymaking

Case studies allow researchers and practitioners to learn from the specifics of a situation and apply that learning in similar situations. Ethics case studies allow such reflection to facilitate the development of ethical decision-making skills. This volume has major interests in ethics and evidence-generation (research), but also in a third area: policymaking. Cases can influence policymaking, such as how one case can receive widespread attention and become the impetus to create policy that aims to prevent similar cases. For example, the US federal Brady Law was enacted in 1993 to require background checks on people before they purchase a gun (ATF 2021 ). The law was named for White House Press Secretary James Brady, and his case became widely known in the US. He was shot and paralyzed during John Hinckley, Jr.’s 1981 assassination attempt on President Ronald Reagan. Another example, this time in a research context, was how the Tuskegee Syphilis Study led, after its public exposure in 1971, to the US Department of Health, Education and Welfare appointing an expert panel to examine the ethics of that case. This resulted in federal policymakers enacting the National Research Act in 1974, which included setting up a national commission that published the Belmont Report in 1976. This report continues to strongly influence research ethics practice around the world. These examples highlight the power of a case study to influence policymaking.

One of the challenges for policymakers, though, is that compelling cases can often be provided for opposite sides of an issue. Also, while the Belmont Report has been praised for articulating a small number of key ethical principles, how those principles should be applied in specific instances of research remains an ongoing challenge and a point of much discussion. This is particularly relevant for innovative techniques and technologies. Hence the importance of cases interacting with general principles and leading to ongoing reflection and debate over the applicable cases. At the same time, new areas of research and evidence generation activities will lead to questions about how existing ethical principles and values apply. New case studies can help to facilitate that reflection, which can then allow policymakers to consider whether existing policy should be adapted or whether whole new areas of policy are needed.

Case studies also can play an important role in learning from and evaluating policy. Policymakers tend to focus on practical, day-to-day concerns and with the introduction of new programmes (Exworthy and Peckam 2012 ). Time and resources may be scant when it comes to evaluating how well existing policies are performing or reflecting on how policies can be adapted to overcome shortcomings (Hunter 2003 ). Effective policies may exist elsewhere (historically or geographically) and be more easily adapted to a new context instead of starting policymaking from scratch. Case studies can permit learning from past policies (or situations where policies did not exist), and they can illuminate various factors that should be explored in more detail in the context of the current issue or situation. Chaps. 2 , 3 and 5 in this volume are examples of this type of case study.

1.6. The Moral Gain

This volume reflects the ambiguity of ethical dilemmas in contemporary policymaking. Analyses will reflect current debates where consensus has not been achieved yet. These cases illustrate key points made throughout the PRO-RES project: that ethical decision-making is a fluid enterprise, where values, principles and standards must constantly be applied to new situations, new events and new research developments. The cases illustrate how no ‘one point’ exists in the research process where judgements about ethics can be regarded as ‘final.’ Case studies provide excellent ways for readers to develop important decision-making skills.

Research produces novel products and processes which can have broad implications for society, the environment and relationships. Research methods themselves are modified or applied in new ways and places, requiring further ethical reflection. New topics and whole fields of research develop and require careful evaluation and thoughtful responses. New case studies are needed because research constantly generates new issues and new ethics questions for policymaking.

The cases found in this volume address a wide range of topics and involve several disciplines. The cases were selected by the parameters of the PRO-RES project and the Horizon 2020 funding call to which it responded. First, the call was concerned with both research ethics and scientific integrity and each of the cases addresses one or both of these areas. The call sought projects that addressed non-medical research, and the cases here address disciplines such as social sciences, engineering, artificial intelligence and One Health. The call also sought particular attention be given to (a) covert research, (b) working in dangerous areas/conflict zones and (c) behavioral research collecting data from social media/internet sources. Hence, we included cases that addressed each of these areas. Finally, while an EU-funded project can be expected to have a European focus, the issues addressed have global implications. Therefore, we wanted to include cases studies from outside Europe and did so by involving authors from India and Africa to reflect on the volume’s areas of interest.

The first case study offered in this volume (Chap. 2 ) examines a significant policy approach taken by the European Union to address ethics and integrity in research and innovation: Responsible Research and Innovation (RRI). This chapter examines the lessons that can be learned from RRI in a European context. Chapter 3 elaborates on this topic with another policy learning case study, but this time examining RRI in India. One of the critiques made of RRI is that it can be Euro-centric. This case study examines this claim, and also describes how a distinctively Indian concept, Scientific Temper, can add to and contextualise RRI. Chapter 4 takes a different approach in being a case study of the development of research ethics guidance in the United Kingdom (UK). It explores the history underlying the research ethics framework commissioned by the UK Research Integrity Office (UKRIO) and the Association of Research Managers and Administrators (ARMA), and points to lessons that can be learned about the policy-development process itself.

While staying focused on policy related to research ethics, the chapters that follow include case studies that address more targeted concerns. Chapter 5 examines the impact of the European Union’s (EU) General Data Protection Regulation (GDPR) in the Republic of Croatia. Research data collected in Croatia is used to explore the handling of personal data before and after the introduction of GDPR. This case study aims to provide lessons learned that could contribute to research ethics policies and procedures in other European Member States.

Chapter 6 moves from policy itself to the role of policy advisors in policymaking. This case study explores the distinct responsibilities of those elevated to the role of “policy advisor,” especially given the current lack of policy to regulate this field or how its advice is used by policymakers. Next, Chap. 7 straddles the previous chapters’ focus on policy and its evaluation while introducing the focus of the next section on historical case studies. This chapter uses the so-called “race for the superconductor” as a case study by which the PRO-RES ethics framework is used to explore specific ethical dilemmas (PRO-RES 2021b ). This case study is especially useful for policymakers because of how it reveals the multiple difficulties in balancing economic, political, institutional and professional requirements and values.

The next case study continues the use of historical cases, but here to explore the challenges facing innovative research into unorthodox energy technology that has the potential to displace traditional energy suppliers. The wave power case in Chap. 8 highlights how conducting research with integrity can have serious consequences and come with considerable cost. The case also points to the importance of transparency in how evidence is used in policymaking so that trust in science and scientists is promoted at the same time as science is used in the public interest. Another area of cutting-edge scientific innovation is explored in Chap. 9 , but this time looking to the future. This case study examines space exploration, and specifically the ethical issues around establishing safe exposure standards for astronauts embarking on extended duration spaceflights. This case highlights the ethical challenges in policymaking focused on an elite group of people (astronauts) who embark on extremely risky activities in the name of science and humanity.

Chapter 10 moves from the physical sciences to the social sciences. The Belfast Project provides a case study to explore the ethical challenges of conducting research after violent conflict. In this case, researchers promised anonymity and confidentiality to research participants, yet that was overturned through legal proceedings which highlighted the limits of confidentiality in research. This case points to the difficulty of balancing the value of research archives in understanding conflict against the value of providing juridical evidence to promote justice. Another social science case is examined in Chap. 11 , this time in ethnography. This so-called ‘urban explorer’ case study explores the justifications that might exist for undertaking covert research where researchers break the law (in this case by trespassing) in order to investigate a topic that would remain otherwise poorly understood. This case raises a number of important questions for policymakers around: the freedoms that researchers should be given to act in the public interest; when researchers are justified in breaking the law; and what responsibilities and consequences researchers should accept if they believe they are justified in doing so.

Further complexity in research and evidence generation is introduced in Chap. 12 . A case study in One Health is used to explore ethical issues at the intersection of animal, human and environmental ethics. The pertinence of such studies has been highlighted by COVID-19, yet policies lag behind in recognising the urgency and complexity of initiating investigations into novel outbreaks, such as the one discussed here that occurred among animals in Ethiopia. Chapter 13 retains the COVID-19 setting, but returns the attention to technological innovation. Artificial intelligence (AI) is the focus of these two chapters in the volume, here examining the ethical challenges arising from the emergency authorisation of using AI to respond to the public health needs created by the COVID-19 pandemic. Chapter 14 addresses a longer term use of AI in addressing problems and challenges in the legal system. Using the so-called Robodebt case, the chapter explores the reasons why legal systems are turning to AI and other automated procedures. The Robodebt case highlights problems when AI algorithms are built on inaccurate assumptions and implemented with little human oversight. This case shows the massive problems for hundreds of thousands of Australians who became victims of poorly conceived AI and makes recommendations to assist policymakers to avoid similar debacles. The last chapter (Chap. 15 ) draws some general conclusions from all the cases that are relevant when using case studies.

1.7. Into the Future

This volume focuses on ethics in research and professional integrity and how we can be clear about the lessons that can be drawn to assist policymakers. The cases provided cover a wide range of situations, settings, and disciplines. They cover international, national, organisational, group and individual levels of concern. Each case raises distinct issues, yet also points to some general features of research, evidence-generation, ethics and policymaking. All the studies illustrate the difficulties of drawing clear ‘boundaries’ between the research and the context. All these case studies show how in real situations dynamic judgements have to be made about many different issues. Guidelines and policies do help and are needed. But at the same time, researchers, policymakers and everyone else involved in evidence generation and evidence implementation need to embody the virtues that are central to good research. Judgments will need to be made in many areas, for example, about how much transparency can be allowed, or is ethically justified; how much risk can be taken, both with participants’ safety and also with the researchers’ safety; how much information can be disclosed to or withheld from participants in their own interests and for the benefit of the ‘science’; and many others. All of these point to just how difficult it can be to apply common standards across disciplines, professions, cultures and countries. That difficulty must be acknowledged and lead to open discussions with the aim of improving practice. The cases presented here point to efforts that have been made towards this. None of them is perfect. Lessons must be learned from all of them, towards which Chap. 15 aims to be a starting point. Only by openly discussing and reflecting on past practice can lessons be learned that can inform policymaking that aims to improve future practice. In this way, ethical progress can become an essential aspect of innovation in research and evidence-generation.

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PRO-RES is a European Commission-funded project aiming to PROmote ethics and integrity in non-medical RESearch by building a supported guidance framework for all non-medical sciences and humanities disciplines adopting social science methodologies. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 788352. Open access fees for this volume were paid for through the PRO-RES funding.

Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

• Cite this Page O’Mathúna D, Iphofen R. Making a Case for the Case: An Introduction. 2022 Nov 3. In: O'Mathúna D, Iphofen R, editors. Ethics, Integrity and Policymaking: The Value of the Case Study [Internet]. Cham (CH): Springer; 2022. Chapter 1. doi: 10.1007/978-3-031-15746-2_1
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In this Page

• Judging the Ethics of Research
• The Case for Cases
• Research Design and Causal Inference
• Devil’s in the Detail
• Cases and Policymaking
• The Moral Gain
• Into the Future

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• Discussion Forum
• Why and How: Using the Case Study Method in the Law Classroom

Post by: Jackie Kim and Lisa Brem

Why should legal educators use case studies and other experiential teaching methods, such as role plays and simulations, in their classes?  Hasn’t the Langdell method served legal education well these last 140 years?  Certainly creating and using experiential materials requires a different set of skills from faculty, elicits a different response and level of engagement from students, and poses barriers to implementation. The ABA’s LEAPS Project [i] has a comprehensive list of objections to practical problem solving in the classroom: materials are time consuming and expensive to create and deploy; addition of a case study or simulation to a syllabus inherently displaces other material; and there are few incentives from law school leaders to introduce this type of teaching.

Yet, the argument promoting experiential materials and techniques is strong. The 2007 Carnegie Report [ii] recommended integrating lawyering skills practice into the curriculum alongside doctrinal courses, and the ABA added simulation courses to the list of practical experiences that can and should be offered by law schools in its 2015 Guidance Memo [iii] .

In a 2007 Vanderbilt Law Review article [iv] , HLS Dean Martha Minow and Professor Todd D. Rakoff argued that Langdell’s approach to teaching students using appellate cases does not do enough to prepare law students for real-world problems: “The fact is, Langdell’s case method is good for some things, but not good for others. We are not talking about fancy goals here; we are talking about teaching students ‘how to think like a lawyer.’”

But does the case study method result in a higher degree of student learning? While we have not yet seen a study on the efficacy of the case study method vs. the Langdell method in law schools, research [v] from political science professor Matthew Krain suggests that case studies and problem-based activities do enhance certain types of learning over other types of pedagogy.  In his investigation, Krain compared the results of pre-and post-course surveys of students who participated in active learning with those who received a traditional lecture course. The case studies and problems that Krain used in his non-traditional classes included: case studies in the form of popular press articles, formal case studies, films, or problem-based case exercises that required students to produce a work product.

Krain found that:

Student-centered reflection, in which students have the opportunity to discuss their understanding of the case, allows both students and instructors to connect active learning experiences back to a larger theoretical context. Case learning is particularly useful for dramatizing abstract theoretical concepts, making seemingly distant events or issues seem more “authentic” or “real,” demonstrating the connection between theory and practice, and building critical-thinking and problem-solving skills (Inoue & Krain, 2014; Krain, 2010; Kuzma & Haney, 2001; Lamy, 2007; Swimelar, 2013).

This study suggests that case-based approaches have great utility in the classroom, and they should be used more often in instances where students’ understanding of conceptual complexity or knowledge of case details is critical. Moreover, case-based exercises can be derived from a variety of different types of materials and still have great utility. If deployed selectively in the context of a more traditional classroom setting as ways to achieve particular educational objectives, case-based approaches can be useful tools in our pedagogical toolbox.

For those who might be ready to try a case study, role play, or simulation, there are resources that can help.  Harvard Law School produces case studies for use throughout the legal curriculum. The HLS Case Studies program publishes these teaching materials, and makes them available to educators, academic staff, students, and trainers. Outside of Harvard Law School, links to resources for educators implementing the case study method can be found on the Case Studies Program Resources page. Listed are case study affiliates at Harvard, legal teaching and learning tools, tips for case teaching, and free case materials. Examples include the Legal Education, ADR, and Practical Problem Solving (LEAPS) Project [vi] from the American Bar Association , which provides resources for various topics on legal education, and the Teaching Post , an educators’ forum offered by the Harvard Business School where professors can seek or provide advice on case study teaching.

“… [O]ur society is full of new problems demanding new solutions, and less so than in the past are lawyers inventing those solutions. We think we can, and ought to, do better.” – Dean Martha Minow & Professor Todd Rakoff. [vii]

[i] “Overcoming Barriers to Teaching ‘Practical Problem-Solving’.” Legal Education, ADR & Practical Problem-Solving (LEAPS) Project, American Bar Association, Section of Dispute Resolution. Accessed March 16, 2017, http://leaps.uoregon.edu/content/overcoming-barriers-teaching-%E2%80%9Cpractical-problem-solving%E2%80%9D. [ii] William M. Sullivan, Anne Colby, Judith Welch Wegner, Lloyd Bond, and Lee S. Shulman, “Educating Lawyers,”  The Carnegie Foundation for the Advancement of Teaching (2007). [iii] American Bar Association, “Managing Director’s Guidance Memo,”  Section of Legal Education and Admissions to the Bar  (2015). [iv] Martha Minow and Todd D. Rakoff, “A Case for Another Case Method,” Vanderbilt Law Review 60(2) (2007): 597-607. [v] Matthew Krain, “Putting the learning in case learning? The effects of case-based approaches on student knowledge, attitudes, and engagement,” Journal on Excellence in College Teaching 27(2) (2016): 131-153. [vi] “Overcoming Barriers to Teaching ‘Practical Problem-Solving’.” [vii] Minow and Rakoff.

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Bringing law to life through real-world case studies

First year module introduces students to law by exploring the interaction of legal norms with climate change and homelessness, as Professor Maria Lee, UCL Laws, explains

21 March 2019

In 2018, UCL Laws introduced an ambitious, innovative, compulsory induction module for first year law students, Laws’ Connections: Legal Doctrine and Contemporary Challenges . 

Teaching through case studies 

The case study is the central teaching methodology for Laws’ Connections . In 2018, four case studies were available, of which each student took two: 

• climate change
• the gig economy
• homelessness
• medical accidents

In Laws’ Connections , students begin their time with us by engaging with the way that the legal system and legal norms interact with a social issue, rather than from the perspective of a legal category (such as contract, property or crime). This means that we can begin to think critically and deeply about law and ideas right from the start, even as the students are just beginning to develop their knowledge of legal doctrine. We are also able to explore some necessary introductory material on basic legal structures and legal concepts, which can seem quite abstract and dry at this stage, in a more urgent and compelling way. 

The case studies also introduce students to some important legal skills, and we require them to: 

• read (part of) a case
• read (part of) a statute
• read (part of) an academic article
• carry out a written exercise
• do some group work
• contribute to an oral presentation. 

Careful support is provided in small groups for each of these activities, and detailed feedback provided.

Supporting the transition to university

Each case study is made up of 5x3 hour classes, and involves no compulsory out of class preparation (save preparing for the final assessment). Time for reading and thinking is provided within the schedule, in a small group of peers, with a teacher. This reduces anxiety and allows students the space to settle into the broader social side of university life, as well as guiding expectations. 

Introducing the study of law

In addition to the case studies, each student on Laws’ Connections takes Introduction to Law . A moodle site is available for new students to access before they arrive at UCL. It includes bespoke material that I produced in four chapters: 

• Introduction to law at UCL
• What is law (for)?
• Structure of the English legal system
• Lawyers and the legal profession

Each chapter contains links to reading from various sources, including chapters from introductory English Legal System texts, as well as websites and more ‘popular’ books such as The Secret Barrister . 

A number of colleagues made short (under 5 minute) videos on various foundational or important legal issues – UCL made us all look rather wonderful, and this personalized and livened up potentially dry material. 

The Introduction to Law element of Laws’ Connections also includes a series of skills lectures, including topics like essay writing, problem solving, getting the most out of lectures and tutorials [see Case Study:  It's a trap! How I got students to engage with assessment: the power of guided marking ] 

Each student is assessed (pass/fail) in one of their two case studies. The assessments this year were comprised of group presentations (two case studies), a blog and an essay. Students can take the assessment as many times as necessary to pass.  

Introduction to Law is assessed by multiple choice questions, with a pass being 20 out of 25. Students can take the test as many times as they need. 

Teaching by staff, students and alumni

I took the lead on developing, designing and running Laws’ Connections , initially in my capacity as Vice-Dean (Programme Development and Delivery), although now simply as module convenor. 

But this sort of innovation takes the commitment of many colleagues. Most obviously, the four case studies were each put together by different people (I led the climate change case study). About a dozen colleagues and students reviewed the case studies and Introduction to Law . 

Equally importantly, convenors of our four compulsory first year subjects ‘donated’ a lecture and a tutorial each.    And nearly fifty individuals taught on Laws’ Connections . Teachers on the case studies included final year law students and some of our recent graduates, as well as all levels of faculty, from post-graduate research students to very experienced professors. The final year students and recent graduates enriched the teaching, and they confirmed in feedback that they gained a great deal from the experience. One thing we had not anticipated was that Laws’ Connections provides a different sort of ‘clinical’ legal experience for our students.

Such an ambitious and intensive programme also requires practical, moral and financial support from senior colleagues, and we had that from the Faculty of Laws Dean’s Team and the Dean. 

And of course, without the enthusiasm of our professional services colleagues for improving the student experience, and their extraordinary support, we could not have done this. 

The inspiration for Laws’ Connections

It had never been my ambition to develop such an ambitious initiative. Laws’ Connections emerged from many discussions with a large number of colleagues and students about our experiences and our hopes. 

We reflected on the enormous privilege of engaging with all of these young people, on their first steps in the transformative experience of higher education, within our walls and within our discipline. What did we really want their first experience to be? 

Student and staff responses

We asked for anonymous feedback about Laws Connections from students and staff:

Student feedback

“ Laws Connections introduced me to the integration of the law into society and the importance of it in the issues that we face today. 

“ It gave me a better understanding of how law works in the UK, in terms of how legislation is passed and how power is distributed. It also introduced the ethical issues that lawyers could potentially face.

“ The best thing about Laws’ Connections was being able to speak to different academics, students or experts about each topic, since every single person has a different aspect to introduce to your analysis.

Staff feedback

“ The opportunity to introduce students to the connection between law and social issues, and to law in action, so early in their degree studies was fantastic. The teaching teams worked incredibly well - there was a team camaraderie and enthusiasm that made the teaching experience especially rewarding and also engaged students in the subject matter.

“ The programme is very exciting...I'm not sure the students will have realised just how much they have learned about how to be a law student.

Laws' Connections: future development and broader impact

These things don’t and shouldn’t last forever. But Laws’ Connections does feel sustainable, and should be able to flourish and evolve for a number of years. A few colleagues are working on additional case studies for 2019 and 2020, and many colleagues are keen to stay involved, or to get involved for the first time next year. We want to work harder on integrating Laws’ Connections into the rest of our programme. 

We’re all applying the experience of teaching Laws’ Connections to other areas of our teaching and professional lives. Through some of our conversations around Laws’ Connections , we’ve empowered ourselves to teach across the curriculum in the way we think best. 

Top tips for introducing new modules to your courses

• Take the time to build a level of consensus and enthusiasm among colleagues – this sort of ambitious programme does not work without buy in. 
• Give it the time and resources it needs. We started our reflective workshops in January 2017, and spent much of the rest of the year working around the issues with colleagues. The faculty agreed to go ahead at the Education Away Day in November 2017, and we ran Laws’ Connections for the first time in September 2018.
• This sort of thing succeeds only if a core group is committed to making this work – don’t underestimate the challenge. 
• But don’t underestimate how rewarding this can be! For those developing the initiative, for colleagues, and most importantly for students.   

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Blog about Writing Case Study and Coursework

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How to Write an Introduction for a Case Study Report

If you’re looking for examples of how to write an introduction for a case-study report, you’ve come to the right place. Here you’ll find a sample, guidelines for writing a case-study introduction, and tips on how to make it clear. In five minutes or less, recruiters will read your case study and decide whether you’re a good fit for the job.

Example of a case study introduction

An example of a case study introduction should be written to provide a roadmap for the reader. It should briefly summarize the topic, identify the problem, and discuss its significance. It should include previous case studies and summarize the literature review. In addition, it should include the purpose of the study, and the issues that it addresses. Using this example as a guideline, writers can make their case study introductions. Here are some tips:

The first paragraph of the introduction should summarize the entire article, and should include the following sections: the case presentation, the examinations performed, and the working diagnosis, the management of the case, and the outcome. The final section, the discussion, should summarize the previous subsections, explain any apparent inconsistencies, and describe the lessons learned. The body of the paper should also summarize the introduction and include any notes for the instructor.

The last section of a case study introduction should summarize the findings and limitations of the study, as well as suggestions for further research. The conclusion section should restate the thesis and main findings of the case study. The conclusion should summarize previous case studies, summarize the findings, and highlight the possibilities for future study. It is important to note that not all educational institutions require the case study analysis format, so it is important to check ahead of time.

The introductory paragraph should outline the overall strategy for the study. It should also describe the short-term and long-term goals of the case study. Using this method will ensure clarity and reduce misunderstandings. However, it is important to consider the end goal. After all, the objective is to communicate the benefits of the product. And, the solution should be measurable. This can be done by highlighting the benefits and minimizing the negatives.

Structure of a case study introduction

The structure of a case study introduction is different from the general introduction of a research paper. The main purpose of the introduction is to set the stage for the rest of the case study. The problem statement must be short and precise to convey the main point of the study. Then, the introduction should summarize the literature review and present the previous case studies that have dealt with the topic. The introduction should end with a thesis statement.

The thesis statement should contain facts and evidence related to the topic. Include the method used, the findings, and discussion. The solution section should describe specific strategies for solving the problem. It should conclude with a call to action for the reader. When using quotations, be sure to cite them properly. The thesis statement must include the problem statement, the methods used, and the expected outcome of the study. The conclusion section should state the case study’s importance.

In the discussion section, state the limitations of the study and explain why they are not significant. In addition, mention any questions unanswered and issues that the study was unable to address. For more information, check out the APA, Harvard, Chicago, and MLA citation styles. Once you know how to structure a case study introduction, you’ll be ready to write it! And remember, there’s always a right and wrong way to write a case study introduction.

During the writing process, you’ll need to make notes on the problems and issues of the case. Write down any ideas and directions that come to mind. Avoid writing neatly. It may impede your creative process, so write down a rough draft first, and then draw it up for your educational instructor. The introduction is an overview of the case study. Include the thesis statement. If you’re writing a case study for an assignment, you’ll also need to provide an overview of the assignment.

Guidelines for writing a case study introduction

A case study is not a formal scientific research report, but it is written for a lay audience. It should be readable and follow the general narrative that was determined in the first step. The introduction should provide background information about the case and its main topic. It should be short, but should introduce the topic and explain its context in just one or two paragraphs. An ideal case study introduction is between three and five sentences.

The case study must be well-designed and logical. It cannot contain opinions or assumptions. The research question must be a logical conclusion based on the findings. This can be done through a spreadsheet program or by consulting a linguistics expert. Once you have identified the major issues, you need to revise the paper. Once you have revised it twice, it should be well-written, concise, and logical.

The conclusion should state the findings, explain their significance, and summarize the main points. The conclusion should move from the detailed to the general level of consideration. The conclusion should also briefly state the limitations of the case study and point out the need for further research in order to fully address the problem. This should be done in a manner that will keep the reader interested in reading the paper. It should be clear about what the case study found and what it means for the research community.

The case study begins with a cover page and an executive summary, depending on your professor’s instructions. It’s important to remember that this is not a mandatory element of the case study. Instead, the executive summary should be brief and include the key points of the study’s analysis. It should be written as if an executive would read it on the run. Ultimately, the executive summary should include all the key points of the case study.

Clarity in a case study introduction

Clarity in a case study introduction should be at the heart of the paper. This section should explain why the case was chosen and how you decided to use it. The case study introduction varies according to the type of subject you are studying and the goals of the study. Here are some examples of clear and effective case study introductions. Read on to find out how to write a successful one. Clarity in a case study introduction begins with a strong thesis statement and ends with a compelling conclusion.

The conclusion of the case study should restate the research question and emphasize its importance. Identify and restate the key findings and describe how they address the research question. If the case study has limitations, discuss the potential for further research. In addition, document the limitations of the case study. Include any limitations of the case study in the conclusion. This will allow readers to make informed decisions about whether or not the findings are relevant to their own practices.

A case study introduction should include a brief discussion of the topic and selected case. It should explain how the study fits into current knowledge. A reader may question the validity of the analysis if it fails to consider all possible outcomes. For example, a case study on railroad crossings may fail to document the obvious outcome of improving the signage at these intersections. Another example would be a study that failed to document the impact of warning signs and speed limits on railroad crossings.

As a conclusion, the case study should also contain a discussion of how the research was conducted. While it may be a case study, the results are not necessarily applicable to other situations. In addition to describing how a solution has solved the problem, a case study should also discuss the causes of the problem. A case study should be based on real data and information. If the case study is not valid, it will not be a good fit for the audience.

Sample of a case study introduction

A good case study introduction serves as a map for the reader to follow. It should identify the research problem and discuss its significance. It should be based on extensive research and should incorporate relevant issues and facts. For example, it may include a short but precise problem statement. The next section of the introduction should include a description of the solution. The final part of the introduction should conclude with the recommended action. Once the reader has a sense of the direction the study will take, they will feel confident in pursuing the study further.

In the case of social sciences, case studies cannot be purely empirical. The results of a case study can be compared with those of other studies, so that the case study’s findings can be assessed against previous research. A case study’s results can help support general conclusions and build theories, while their practical value lies in generating hypotheses. Despite their utility, case studies often contain a bias toward verification and tend to confirm the researcher’s preconceived notions.

In the case of case studies, the conclusions section should state the significance of the findings, stating how the findings of the study differ from other previous studies. Likewise, the conclusion section should summarize the key findings, and make the reader understand how they address the research problem. In the case of a case study, it is crucial to document any limitations that have been identified. After all, a case study is not complete without further research.

After the introduction, the main body of the paper is the case presentation. It should provide information about the case, such as the history, examination results, working diagnosis, management, and outcome. It should conclude with a discussion, explaining the correlations, apparent inconsistencies, and lessons learned. Finally, the conclusion should state whether the case study presented the results in the desired way. The findings should not be overgeneralized, and the conclusions must be derived from this information.

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HHS Announces Cost Savings for 64 Prescription Drugs Thanks to the Medicare Rebate Program Established by the Biden-Harris Administration’s Lower Cost Prescription Drug Law

Under President Biden’s Inflation Reduction Act, some people with Medicare will pay less for some Part B drugs if the drug’s price increased faster than the rate of inflation.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today announced that some Medicare enrollees will pay less for 64 drugs available through Medicare Part B. The drugs will have a lowered Part B coinsurance rate from July 1, 2024 – September 30, 2024, since each drug company raised prices faster than the rate of inflation.  Over 750,000 people with Medicare use these drugs annually, which treat conditions such as osteoporosis, cancer, and infections. White House Domestic Policy Advisor Neera Tanden will announce the cost savings on these life-saving drugs in a keynote address on the Biden-Harris Administration’s focus on lowering costs today at the Center for American Progress.

“Without the Inflation Reduction Act, seniors were completely exposed to Big Pharma’s price hikes. Not anymore. Thanks to President Biden and the new Medicare inflation rebate program, seniors are protected and benefitting from lower Part B drug costs,” said White House Domestic Policy Advisor Neera Tanden. “The Biden-Harris Administration will continue fighting to bring down the cost of health care and prescription drugs for all Americans.”

“President Biden’s Medicare prescription drug rebate program is putting money back in the pockets of seniors and people with disabilities, said HHS Secretary Xavier Becerra. “President Biden made lowering prescription drug costs for Americans a top priority, and he is delivering on that promise. Our work is not complete, and we will continue to fight for lower health care costs for all Americans.”

Please find soundbites from HHS’ Chief Competition Officer, Stacy Sanders, here .

Because of President Biden’s lower cost prescription drug law, the Inflation Reduction Act, which established the Medicare Prescription Drug Inflation Rebate Program, some people with Medicare who use these drugs during this time period may save between $1 and $4,593 per day.

“Everyone should be able to afford their medication, and the Inflation Reduction Act continues to deliver on this goal to improve affordability,” said CMS Administrator Chiquita Brooks-LaSure. “Discouraging drug companies from price increases above the rate of inflation is a key part of this effort, and CMS continues to implement the law to bring savings to people with Medicare.”

Padcev, a medication used to treat advanced bladder cancer, is an example of a prescription drug with a price that has increased faster than the rate of inflation every quarter since the Medicare Part B inflation rebate program went into effect, resulting in lowered Part B coinsurances for seniors and others with Medicare. A beneficiary taking Padcev as part of their cancer treatment may have saved as much as $1,181 from April 1, 2023 through March 31, 2024, depending on their coverage and course of treatment. Another example, Crysvita, treats a rare genetic disorder that causes impaired growth, muscle weakness, and bone pain. A beneficiary taking Crysvita may have saved as much as $765 from July 1, 2023 through March 31, 2024 depending on their coverage and course of treatment.

The Medicare Prescription Drug Inflation Rebate Program is just one of the Inflation Reduction Act’s prescription drug provisions aimed at lowering drug costs. In addition to this program, the law expanded eligibility for full benefits under the Low-Income Subsidy program (LIS or “Extra Help”) under Medicare Part D at the beginning of this year. Nearly 300,000 people with low and modest incomes are now benefiting from the program’s expansion. A comprehensive public education campaign is underway to reach the more than three million people who are likely eligible for the program but not yet enrolled.

In addition, as of January 1, 2024, some people enrolled in Medicare Part D who have high drug costs have their annual out-of-pocket costs capped at about $3,500. In 2025, all people with Medicare Part D will benefit from a $2,000 cap on annual out-of-pocket prescription drug costs.

The Inflation Reduction Act requires drug companies to pay rebates to Medicare when prices increase faster than the rate of inflation for certain drugs. CMS intends to begin invoicing prescription drug companies for rebates owed to Medicare no later than fall 2025. The rebate amounts paid by drug companies will be deposited in the Federal Supplementary Medical Insurance Trust Fund, which will help ensure the long-term sustainability of the Medicare program for future generations.

For more information on the Medicare Prescription Drug Inflation Rebate Program visit, https://www.cms.gov/inflation-reduction-act-and-medicare/inflation-rebates-medicare

To view the fact sheet on the 64 Part B drugs with a coinsurance reduction for the quarter July 1, 2024 – September 30, 2024, visit, https://www.cms.gov/files/document/reduced-coinsurance-certain-part-b-rebatable-drugs-july-1-september-30-2024.pdf

More information and helpful resources about the Inflation Reduction Act and how it is helping to lower costs for people with Medicare can be found at LowerDrugCosts.gov .

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Hhs publishes first round of inflation reduction act case studies on health sector climate investments, hhs releases new data showing over 10 million people with medicare received a free vaccine because of the president’s inflation reduction act; releases draft guidance for the second cycle of medicare drug price negotiation program, biden-harris administration furthers medicare drug price negotiations, releases new data on how the president’s historic law lowers health care costs for women, media inquiries.

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Things to know about the gender-affirming care case as the Supreme Court prepares to weigh in

FILE - A flag supporting LGBTQ+ rights decorates a desk on the Democratic side of the Kansas House of Representatives during a debate, March 28, 2023, at the Statehouse in Topeka, Kan. The U.S. Supreme Court agreed Monday to consider whether a Tennessee ban on gender-affirming care for minors is constitutional. (AP Photo/John Hanna, File)

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The U.S. Supreme Court said Monday that it will hear arguments on the constitutionality of state bans on gender-affirming care for transgender minors.

The issue has emerged as a big one in the past few years. While transgender people have gained more visibility and acceptance in many respects, half the states have pushed back with laws banning certain health care services for transgender kids.

Things to know about the issue:

What is gender-affirming care?

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth.

The services are offered to treat gender dysphoria, the unease a person may have because their assigned gender and gender identity don’t match. The condition has been linked to depression and suicidal thoughts.

Gender-affirming care encompasses counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes. Those for transgender men cause periods to stop, increase facial and body hair, and deepen voices, among others. The hormones used by transgender women can have effects such as slowing growth of body and facial hair and increasing breast growth.

Gender-affirming care can also include surgery, including operations to transform genitals and chests. These surgeries are rarely offered to minors .

What laws are states passing?

Over the past three years, 26 Republican-controlled states have passed laws restricting gender-affirming care for minors. Most of the laws ban puberty blockers, hormone treatment and surgery for those under 18. Some include provisions that allow those already receiving treatment to continue.

The laws also make exceptions for gender-affirming treatments that are not part of a gender transition, such as medications to stop breast growth in boys and excessive facial hair in girls.

One of the laws — in Arkansas — was nixed by a federal court and is not being enforced.

Meanwhile, at least 14 Democratic-controlled states have adopted laws intended to protect access to gender-affirming care.

The gender-affirming care legislation is a major part of a broader set of laws and policies that has emerged in Republican-controlled states that rein in rights of transgender people. Other policies, adopted in the name of protecting women and girls, bar transgender people from school bathrooms and sports competitions that align with their gender.

What have courts said so far?

Most of the bans have faced court challenges, and most are not very far along in the legal pipeline yet.

The law in Arkansas is the only one to have been struck down entirely, but the state has asked a federal appeals court to reverse that ruling.

The 6th U.S. Circuit Court of Appeals, one step below the Supreme Court, last year ruled that Kentucky and Tennessee can continue to enforce their bans amid legal challenges. The high court has agreed to hear the Tennessee case in the term that starts later this year.

The U.S. Supreme Court in April ruled that Idaho can enforce its ban while litigation over it proceeds. A lower court had put it on hold.

What does the medical community think?

Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed the bans and said that gender-affirming treatments can be medically necessary and are supported by evidence.

But around the world, medical experts and government health officials are not in lockstep. Some European countries in recent years have warned about overdiagnosis of gender dysphoria.

In England, the state-funded National Health Service commissioned a review of gender identity services for children and adolescents, appointing retired pediatrician Dr. Hilary Cass to lead the effort. The final version of the Cass Review , published in April, found “no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

England’s health service stopped prescribing puberty blockers to children with gender dysphoria outside of a research setting, following recommendations from Cass’ interim report.

The World Professional Association for Transgender Health and its U.S. affiliate issued a statement in May saying they’re deeply concerned about the process, content and consequences of the review, saying it “deprives young trans and gender diverse people of the high-quality care they deserve and causes immense distress and harm to both young patients and their families.”

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Advancing drug-response prediction using multi-modal and -omics machine learning integration (MOMLIN): a case study on breast cancer clinical data

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Md Mamunur Rashid, Kumar Selvarajoo, Advancing drug-response prediction using multi-modal and -omics machine learning integration (MOMLIN): a case study on breast cancer clinical data, Briefings in Bioinformatics , Volume 25, Issue 4, July 2024, bbae300, https://doi.org/10.1093/bib/bbae300

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The inherent heterogeneity of cancer contributes to highly variable responses to any anticancer treatments. This underscores the need to first identify precise biomarkers through complex multi-omics datasets that are now available. Although much research has focused on this aspect, identifying biomarkers associated with distinct drug responders still remains a major challenge. Here, we develop MOMLIN, a multi-modal and -omics machine learning integration framework, to enhance drug-response prediction. MOMLIN jointly utilizes sparse correlation algorithms and class–specific feature selection algorithms, which identifies multi-modal and -omics–associated interpretable components. MOMLIN was applied to 147 patients’ breast cancer datasets (clinical, mutation, gene expression, tumor microenvironment cells and molecular pathways) to analyze drug-response class predictions for non-responders and variable responders. Notably, MOMLIN achieves an average AUC of 0.989, which is at least 10% greater when compared with current state-of-the-art (data integration analysis for biomarker discovery using latent components, multi-omics factor analysis, sparse canonical correlation analysis). Moreover, MOMLIN not only detects known individual biomarkers such as genes at mutation/expression level, most importantly, it correlates multi-modal and -omics network biomarkers for each response class. For example, an interaction between ER-negative-HMCN1-COL5A1 mutations-FBXO2-CSF3R expression-CD8 emerge as a multimodal biomarker for responders, potentially affecting antimicrobial peptides and FLT3 signaling pathways. In contrast, for resistance cases, a distinct combination of lymph node-TP53 mutation-PON3-ENSG00000261116 lncRNA expression-HLA-E-T-cell exclusions emerged as multimodal biomarkers, possibly impacting neurotransmitter release cycle pathway. MOMLIN, therefore, is expected advance precision medicine, such as to detect context–specific multi-omics network biomarkers and better predict drug-response classifications.

The advent of high-throughput sequencing technologies has revolutionized our ability to collect various ‘omics’ data types, such as deoxyribonucleic acid (DNA) methylations, ribonucleic acid (RNA) expressions, proteomics, metabolomics and bioimaging datasets, from the same samples or patients with unprecedented details [ 1 ]. By far, most studies have performed single omics analytics, which capture only a fraction of biological complexity. The integration of these multiple omics datasets offers a more comprehensive understanding of the underlying complex biological processes than single-omic analyses, particularly in human diseases like cancer and cardiovascular disease, where it significantly enhances prediction of clinical outcomes [ 2 , 3 ].

Cancer is a highly complex and deadly disease if left unchecked, and its heterogeneity poses significant challenges for treatment [ 4 ]. Standard treatments, including chemotherapy with or without targeted therapies, aim to reduce tumor burden and improve patient outcomes such as survival rate and quality of life [ 5–7 ]. However, even for the most advanced therapies, such as immunotherapies, treatment effectiveness varies widely across cancer types and even between patients with same diagnosis [ 8 ]. This heterogeneity is believed to be due to tumor microenvironment heterogeneity and their effects on the resultant complex and myriad molecular interactions within cells and tissues [ 9 , 10 ]. This variability underscores the urgent need to identify precise biomarkers to predict individual patient responses and potential adverse reactions to a particular therapy [ 11 ]. This can be made possible through multi-omics data integration analyses at the individual patient scale [ 12 ].

To assess treatment response, such as pathologic complete response (pCR) and residual cancer burden (RCB), current clinical practice relies on clinical parameters (e.g. tumor size/volume and hormone receptor status), along with genetic biomarkers (e.g. TP53 mutations) [ 13–15 ]. However, these approaches do not fully capture the complex intracellular regulatory dynamics [ 16 , 17 ] or the tumor-immune microenvironment (TiME) interactions that influence outcomes [ 18 , 19 ]. Thus, to enhance personalized cancer treatments, we need novel methodologies that can handle large, complex molecular (omics) and clinical datasets. Machine learning (ML) methods integrating multi-omics data offer a promising avenue to improve prediction accuracy and uncover robust biomarkers across drug-response classes [ 20 ], which may be overlooked by single-omics analytics. This approach can predict patients benefiting from standard treatments and those requiring alternative plans like combination therapies or clinical trials.

The current drug-response prediction methods can be broadly categorized into ML-based and network-based approaches. ML methods often analyze each data type (e.g. mutations and gene expression) independently using univariable selection [ 21 , 22 ] or dimension reduction methods [ 23 ]. These results are then integrated using various classifiers or regressors [e.g. support vector machine, elastic-net regressor, logistic regression (LR) and random forest (RF)] [ 24–26 ] and ensemble classifier to make predictions [ 9 ]. However, these methods often overlooked the crucial interactions among different data modalities. Deep learning methods, while gaining popularity, are limited by the need for large clinical sample sizes to achieve sufficient accuracy [ 27 ]. Recent ML advancements have focused on integrating multimodal omics features with patient phenotypes to improve predictive performance [ 28 , 29 ]. To discover multimodal biomarker, techniques such as multi-omics factor analysis (MOFA) and sparse canonical correlation analysis (SCCA), including its variant multiset SCCA (SMCCA) offer realistic strategies for integrating diverse data modalities [ 30–32 ]. However, although these methods are suitable for classification tasks, they are unsupervised and do not directly incorporate phenotypic information (e.g. disease status) to integrate diverse data types. As a result, they are limited to identify phenotype-specific biomarkers.

Recently, advanced supervised approaches like data integration analysis for biomarker discovery using latent components (DIABLO) by Sing et al. (2019) have emerged to overcome these limitations [ 28 ]. DIABLO is an extension of generalized SCCA (GSCCA), considers cross-modality relationships and extracts a set of common factors associated with different response categories. Network-based methods, like unsupervised network fusion or random walk with restart approaches construct drug–target interaction and sample similarity networks that are effective for patient stratification [ 20 , 33 ]. However, these methods lack a specific feature selection design, limiting their utility for identifying biomarkers for patient classification. Nevertheless, none of these ML methods are rigorous in terms of task/class-specific biomarker discovery and interpretability, and both SMCCA and GSCCA struggle with gradient dominance problem due to naive data fusion strategies [ 34 ]. Therefore, it is essential to develop novel interpretable methods for identifying robust multimodal network biomarkers across diverse data types to advance our understanding of the complex factors that influence drug responses.

In this study, we introduce MOMLIN, a multi-modal and -omics ML integration framework to enhance the prediction of anticancer drug responses. MOMLIN integrates weighted multi-class SCCA (WMSCCA) that identifies interpretable components and enables effective feature selection across multi-modal and -omics datasets. Our method contributes in three keyways: (i) innovates a class-specific feature selection strategy with SCCA methods for associating multimodal biomarkers, (ii) includes an adaptive weighting scheme into multiple pairwise SCCA models to balance the influence of different data modalities, preventing dominance during training process and (iii) ensures robust feature selection by employing a combined constraint mechanism that integrate lasso and GraphNet constraints to select both the individual features and subset of co-expressed features, thereby preventing overfitting to high-dimensional data.

We applied MOMLIN to a multimodal breast cancer (BC) dataset of 147 patients comprising clinical features, DNA mutation, RNA expression, tumor microenvironment and molecular pathway data [ 9 ], to predict drug-response classes, specifically distinguishing responders and non-responders. Our results demonstrate MOMLIN’s superiority in terms of outperforming state-of-the-art methods and interpretability of the underlying biological mechanisms driving these distinct response classes.

Overview of our proposed method for treatment response prediction

The workflow of our proposed method MOMLIN for identifying class- or task-specific biomarkers from multimodal data is shown in Fig. 1 . The core of this pipeline involves three stages: (i) identification of response-specific sparse components, in terms of input features and patients, (ii) development of drug-response predictor using latent components of patients and (iii) interpretation of sparse components and multi-modal and -omics biomarker discovery.

Schematic representation of the proposed framework. In stage 1, multimodal datasets from cancer patients (e.g. BC) were sourced from a published study [ 9 ]. This dataset comprises clinical features, DNA mutations, and gene expression from pre-treatment tumors, alongside post-treatment response classes (pCR, RCB-I to III). TiME and pathway activity were derived from transcriptomic data using statistical algorithms. For identifying class-specific correlated biomarkers, class binarization and oversampling were used to balance between classes. WMSCCA models the multimodal associations across different biomarkers and identifies response-specific sparse components on diverse input features and patients. In stage 2, a binary LR classifier then utilizes these patient latent components for predicting response to therapies, evaluated by AUROC. Next in stage 3, class–specific sparse components are shown in a heatmap, highlighting key signatures (non-zero loading) in colors. Finally, the identified multi-modal and -omics signatures then formed a correlation network, revealing pathways associations with multi-modal and -omics biomarkers for each response class. Nodes with colors in the network indicate multimodal features.

The rationales underpinned of this approach is that effective biomarkers are: (i) response–related multimodal features including genes, cell types and pathways, and (ii) features that demonstrate prediction capabilities on unseen patients. The first stage, a ‘feature selection step’ that selects multimodal features on the generated sparse components based on their relevance to drug-response categories (pCR and RCB-I to III). Features with high loading identified are considered as potential biomarker candidates. The second stage, a ‘classification step’, validates these biomarkers by assessing their predictive power in distinguishing responders from non-responders to anticancer therapy; any predictions indicating chemo-resistant tumors should be considered for enrolment in clinical trials for novel therapies. The third stage, an ‘interpretation step,’ analyzes the candidate biomarkers in a multi-modal and-omics network associated with relevant biological pathways. This step aims to elucidate the underlying biological processes differentiating between drug–response phenotypes.

Stage 1. Identification of response-associated sparse components in terms of input features and patients

Multi-modal and -omics data overview and preparation.

This study utilized clinical attributes, DNA mutation and gene expression (transcriptome) data from147 matched samples of early and locally advanced BC patients (categorized as pCR, n  = 38, RCB-I, n  = 23, or RCB-II, n  = 61, or RCB-III, n  = 25), obtained from the TransNEO cohort at Cambridge University Hospitals NHS Foundation [ 9 ]. The dataset includes clinical attributes (8 features, summary attributes are available in Supplementary Table S1 available online at http://bib.oxfordjournals.org/ ), genomic features (31 DNA mutation genes, applying a strict criterion of genes mutated in at least 10 patients) and RNA-sequencing (RNA-Seq) features (18 393 genes), covering major BC subtypes-normal-like, basal-like, Her2, luminalA and luminalB. Although DNA mutation genes typically represent binary data, we used mutation frequencies to construct a mutation count matrix. Initial data pre-processing involved a log2 transformation on the RNA-Seq features after filtering out less informative features at 25th percentile (in terms of mean and standard deviation) using interquartile range. For integrative modeling, we used the top 40% of variable genes (3748 genes, based on median absolute deviation ranking) from the RNA-Seq datasets. Finally, each feature was normalized dividing by its Frobenius norm, adjusting the offset between high and low intensities across different data modalities.

To characterize TiME and pathway markers, we applied various statistical algorithms on the RNA-Seq data. The GSVA algorithm [ 35 ] calculated (i) the GGI gene sets [ 36 ] and (ii) STAT1 immune signature scores [ 37 ]. For immune cell enrichment, three methods were used: (i) MCPcounter [ 37 ] with voom-normalized RNA-Seq counts; (ii) enrichment over 14 cell types using 60 gene markers, employing log2-transformed geometric mean of transcript per million (TPM) expression [ 38 ]; and (iii) z -score scaling of cancer immunity parameters [ 39 ] to classify four immune processes (major histocompatibility complex molecules, immunomodulators, effector cells and suppressor cells). Additionally, the TIDE algorithm [ 40 ] computed T-cell dysfunction and exclusion metrics for each tumor sample using log2-transformed TPM matrix of counts, which can serve as a surrogate biomarker to predict the response to immune checkpoint blockade. Pathway activity scores for each tumor sample were computed using the GSVA algorithm with input gene sets from Reactome [ 41 ], PIP [ 42 ] and BioCarta databases within the MSigDB C2 pathway database [ 43 ].

Sparse multiset canonical correlation analysis

In this study, lowercase letters denote a vector, and uppercase ones denote matrices, respectively. The term |${\left\Vert .\right\Vert}_{1,1}$| denotes the matrix |${l}_1$| -norm, and |${\left\Vert .\right\Vert}_{gn}$| denotes the GraphNet regularization. The sparse multiset canonical correlation analysis (SMCCA) is an extension of dual-view SCCA, proposed to model associations among multiple types of datasets [ 31 ]. Given the multiple types of datasets, let |$X\in{\mathcal{R}}^{n\times p}$| represent gene expression data with |$p$| features, and |${Y}_k\in{\mathcal{R}}^{n\times{q}_k}$| represent the |$k$| -th data modality (e.g. clinical, DNA mutation and tumors microenvironment) with |${q}_k$| features. Both |$X$| and |${Y}_k$| have |$n$| samples, and |$k=\left(1,\dots, K\right)$|⁠ , where |$K$| denotes the number of different data modalities. The objective function of SMCCA is defined as follows:

where |$u$| and |${v}_k$| are the canonical weight vectors corresponding to |$X$| and |${Y}_k$|⁠ , indicating the importance of each respective biomarkers. The term |${\left\Vert .\right\Vert}_1$| represents the |${l}_1$| regularization to detect small subset of discriminative biomarkers and prevent model overfitting. |${\lambda}_u,{\lambda}_{vk}$| are non-negative tuning parameters balancing between the loss function and regularization terms. The term |${\left\Vert .\right\Vert}_2^2$| denotes the squared Euclidean norm to constraint weight vectors |$u$| and as unit length |${v}_k$|⁠ , respectively.

However, SMCCA has limitations: (i) it is naturally unsupervised, meaning SMCCA cannot leverage phenotypic information (e.g. disease status and drug-response classes); (ii) pairwise association among multiple data types can vary significantly and can lead to gradient dominance issues during optimization; and (iii) SMCCA mines a common subset of biomarkers for classifying different tasks, which diminishes its relevance, as each task might require distinct features sets.

Weighted multi-class sparse canonical correlation analysis

To address the above limitations, here we propose weighted multi-class SCCA (WMSCCA), a formal model for class/tasks-specific feature selection, different from the conventional SMCCA. Throughout this study, we used the terms tasks/classes/drug-response classes interchangeably. WMSCCA includes phenotypic information as an additional data type, employs a weighting scheme to resolve the gradient dominance issue and innovates traditional class–specific feature selection strategies through the one-versus-all strategies into its core objective function. In this study, the underlying motivation is WMSCCA can jointly identify drug-response class–specific multimodal biomarkers to improve drug-response prediction. For ease of presentation, we consider |$n$| patients with data matrices |${X}_c\in{\mathcal{R}}^{n\times p},{Y}_{ck}\in{\mathcal{R}}^{n\times{q}_k}$|⁠ , and |$Z\in{\mathcal{R}}^{n\times C}$| from C different drug-response classes. Here, |${X}_c$| denotes |$p$| features from gene expression datasets, |${Y}_{ck}$| denotes |${q}_k$| features from |$k$| -th data modality (e.g. mutation, clinical features, TiME and pathway activity), |${Z}_c$| denotes |$c$| response class, and |$k=\left(1,\dots, K\right)$|⁠ , |$K$| denotes the number of data modalities. The WMSCCA optimization problem can be formulated as follows:

where |$U\in{\mathcal{R}}^{p\times C},{V}_k\in{\mathcal{R}}^{q_k\times C}$| are canonical loading matrices correspond to |$X$| and |${Y}_k$|⁠ , representing the importance of candidate biomarkers for each class |$C$|⁠ , respectively. In this equation, the first term models associations among |$X$|⁠ , and |${Y}_k$| datasets; the second- and third terms correlate class labels |${Z}_c$| with |$X$| and |${Y}_k$| data modalities for each |${C}^{th}$| class, aiming to identify class-specific features and their relationships; |$\psi (U)$| and |$\psi \left({V}_k\right)$| represent sparsity constraints on |$U$| and |${V}_k$|⁠ , to select a subset of discriminative feature. As mentioned in Equation ( 1 ), to address gradient dominance, the adjusting weight parameter |${\sigma}_{xy}$|⁠ , |${\sigma}_{xz}$| and |${\sigma}_{yz}$| can be defined as:

where |$k=\left(1,\dots, K\right)$|⁠ , |$K$| denotes the number of data modalities. |${\sigma}_{..}$| adjusts a larger weight if the non-squared loss (denominator term) between datasets is small and vice versa.

Given high-dimensional datasets, the model in Equation ( 2 ) encounters an overfitting problem. Therefore, the use of a sparsity constraint is appropriate to address this issue. We hypothesized that gene expression biomarkers can be either single genes or co-expressed sets; thus, a combined penalty is designed for the |$X$| dataset. Therefore, |$\psi (U)$| for |$X$| takes the following form:

where, |${\mathrm{\alpha}}_u,\beta$| are nonnegative tuning parameters. |$\beta$| balances between the effect of co-expressed and individual feature selection. The first sparsity constraint is matrix |${l}_{1,1}$| -norm, which is defined as follows:

This penalty promotes class-specific features on |$U$|⁠ . The second sparsity constraint GraphNet regularization, defined as follows:

where |${L}_c$| represents the Laplacian matrices of the connectivity in |$\boldsymbol{X}$| matrices. The Laplacian matrix is defined as |$L=D-A$|⁠ , where |$D$| is the degree matrix of connectivity matrix |$A$| (e.g. gene co-expression or correlation network). This penalty term promotes a subset of connected features to discriminate each response on |$U$|⁠ .

Besides, neither every mutation marker nor every clinical/TiME/pathways involves in predicting response classes, therefore, the |${l}_{1,1}$| -norm is used on the |${Y}_k$| datasets to select individual markers, i.e. |$\psi \left({V}_k\right)$| for the |${\boldsymbol{Y}}_k$| data modalities take the following form:

where |${\mathrm{\alpha}}_{vk}$| is non-negative tuning parameter.

Finally, we obtained C pairs of canonical weight matrices |$\big({U}_c{V}_{ck}\big)\left(c=1,\dots, C;k=1,\dots, K\right)$| using an iterative alternative algorithm by solving Equation ( 2 ) [ 44 , 45 ]. Detected features with non-zero weights in each class in the weight vectors were extracted as correlated sets.

The WMSCCA method involves parameters |${\mathrm{\alpha}}_u,\mathrm{\beta}, and\ {\mathrm{\alpha}}_{vk}$| |$\left(k=1, \dots, K\right)$|⁠ . Given the limited number of samples, we applied a nested cross-validation (CV) strategy on training sets and evaluated the maximum correlation on the test datasets. Optimal values for the regularization parameters were determined within each training set via internal five-fold CV.

Stage 2. Drug-response prediction using latent components of patients

To predict drug-response categories, we trained LR classifier using the latent components of patients (or raw multimodal features) generated by MOMLIN in Fig. 1 : stages 1 and 2. We used a binary classification scheme, distinguishing pCR versus non-pCR, RCB-I versus non-RCB-I, RCB-II versus non-RCB-II and RCB-III versus non-RCB-III, to evaluate model performance. In addition, we performed analyses with existing multi-omics methods, including SMCCA+LR, MOFA+LR, DIABLO and latent principal component analysis (PCA) features, with LR classifiers. To assess prediction performance for the response to treatment in an unbiased manner, we used five-fold cross-validated performance and repeated the process over 100 runs. The partitioning of data was kept consistent across all models for fair comparisons. The accuracy of response prediction was evaluated using area under the receiver operating characteristic curve (AUROC).

Stage 3. Interpretation of sparse components and multi-omics biomarker discovery and their networks

After learning sparse latent components of features across different data modalities using MOMLIN, we identify the most relevant feature based on the loading weight of genes, TiME and pathways, which reveal underlying interactions for discriminating response classes. The larger the loading weight, the more important the pair of features in discriminating response categories. We then use these selected features to construct a sample correlation network, or a relationship matrix based on their canonical weights [ 46 ]. In this network, nodes represent selected features, and the edge weights between two interconnected features indicate correlation or relatedness. The generated network is visualized using the ggraph package in R ( https://cran.r-project.org ). Finally, we prioritize multi-omics biomarkers based on their degree centrality within the interconnected correlation network.

Derivation of response-associated latent components from BC data with MOMLIN

We applied MOMLIN to analyze a breast cancer (BC) dataset to predict treatment response and gain molecular insights. The dataset comprised 147 BC patients with early and locally advanced pretherapy tumors [ 9 ], categorized as follows: pCR with 38 patients, RCB-I (good response) with 23 patients, RCB-II (moderate response) with 61 patients and RCB-III (resistance) with 25 patients. After preprocessing and filtering least informative features, the final dataset comprised 3748 RNA genes (top 40% out of 9371 genes), 31 mutation genes, 8 clinical attributes, 64 TiME and 178 pathways activities ( Fig. 1 : stage 1). Supplementary Table S1 available online at http://bib.oxfordjournals.org/ summarizes overall clinical characteristics by patients’ response classes.

While our proposed framework offers general applicability for identifying context-specific multi-omics biomarkers, this study specifically focused on discovering drug-response–specific biomarkers to enhance the prediction of pCR and RCB resistance. MOMLIN decomposed the input multimodal data into response-associated sparse latent components of input-features and patients. These sparse components reveal patterns of how various features (e.g. genes and mutations) and clinical attributes related to treatment outcomes ( Fig. 1 : stage 1–3), and their effectiveness was evaluated by measuring prediction performance. We assessed the predictive ability of MOMLIN through five-fold CV repeated 100 times. In each iteration, the dataset is divided into five-folds, with one random fold assigned as the held-out test set, and the remaining folds used as the training set. MOMLIN was trained using the training dataset, including detection of predictive marker candidates, and its performance was evaluated on the ‘unseen’ test set. This process was repeated for all five-folds to ensure robust evaluation of MOMLIN’s generalizability. Performance was measured by the AUROC matrices ( Fig. 1 : stage 2).

Performance comparison with existing methods for drug-response prediction

To evaluate the prediction capability of MOMLIN, we modeled each response category as a binary classification problem and compared its prediction accuracy to existing multi-omics integration algorithms. For comparison, we randomly split the dataset into a training set (70%) and a test set (30% unseen data), with balanced inclusion of response classes. We employed LR as the classifier to assess predictive performance of multimodal biomarkers. We compared MOMLIN with four other classification algorithms for omics data: (i) SMCCA, which integrates multi-omics data by projecting it onto latent components for discriminant analysis; (ii) MOFA, which decomposes multi-omics data into common factors for discriminant analysis; (iii) sparse PCA; and (iv) DIABLO, a supervised integrative analysis method, represent the state-of-the-art in classification. All methods were trained on the same preprocessed data.

The classification results showed that MOMLIN outperformed the compared multi-omics integration methods in most classification tasks on unseen test samples ( Fig. 2A ). Notably, DIABLO, the next best performer, was 10 to 15% less effective than our MOMLIN. Additionally, we compared the performance of component-based LR models against raw feature-based LR models to predict RCB response classes. Although raw feature-based models showed improved prediction, their performance was notably dropped compared to component-based models ( Fig. 2B ). This indicates the superior adaptability and effectiveness of component-based models in leveraging multi-omics data for predictive purposes.

Performance comparison with existing methods and detection of informative data combination. All results in the plots depict test AUROC over five-fold CV obtained from 100 runs. (A) Box plots comparing response prediction performance of MOMLIN against existing state-of-the-art multi-omics methods. (B) Performance comparison between predictors based on latent components and those utilizing a selected subset of multimodal features. (C) Comparing AUROCs for the models with different data subset combinations (clinical, clinical + DNA, clinical + RNA and clinical + DNA + RNA) using MOMLIN.

Moreover, to test and demonstrate generalizability of this framework, we applied MOMLIN to a preprocessed multi-omics dataset of colorectal adenocarcinoma (COAD) with 256 patients [ 47 ]. This dataset included gene expression, copy number variations and micro-RNA expression data, which we used to classify COAD subtypes such as chromosomal instability (CIN, n  = 174), genomically stable (GS, n  = 34) and microsatellite instability (MSI, n  = 48). The performance results shown in Supplementary Table S2 available online at http://bib.oxfordjournals.org/ and Supplementary Figure S1 available online at http://bib.oxfordjournals.org/ , indicate that MOMLIN outperformed all state-of-the-art methods tested in classifying COAD subtypes. Moreover, when comparing the raw feature-based accuracies with sparse components-based (features derived from MOMLIN) accuracies, we found that raw feature-based classifier was superior against existing methods ( Figure S1A and B ), but lower than the components-based classifier. This consistent observation supports our findings with BC drug-response performances.

Importance of different omics data for treatment response prediction

To assess the added value of integrating multimodal data for predicting treatment response, we trained four prediction models with different feature combinations: (i) clinical features only, plus adding (ii) DNA, (iii) RNA and (iv) both DNA and RNA. We found that adding different data modalities improved prediction performance across all response classes ( Fig. 2C ). Notably, the models that combined clinical data with either RNA or both DNA and RNA demonstrated superior and comparable performance with an average AUROC of 0.978. In contrast, the model based on clinical features alone had much lower AUROC, ranging from 0.51 to 0.82. These results suggest that RNA transcriptome is the most informative data modality in this dataset. Thus, integrating gene expression with clinical features could significantly improve our ability to predict treatment outcomes in BC.

Interpretation of response-associated sparse components identified by MOMLIN

To understand the molecular landscape of treatment response in BC, we used MOMLIN to model response–specific bi-multivariate associations across multiple data modalities. We observed stronger correlations between RNA gene expression and both TiME ( r  = 0.701) and pathway activity ( r  = 0.868), indicating greater overlap or explained information between them. Conversely, moderate correlations were found between RNA gene expression and DNA mutations ( r  = 0.526), or clinical features ( r  = 0.488), indicating partially overlapping or independent information. These results suggest that multimodal biological features provide complementary information in a combinatorial manner.

When investigating the importance of each feature to predict response classes, MOMLIN identified four distinct loading vectors corresponding to pCR and RCB response classes, highlighting distinct weight patterns for pCR versus non-pCR and RCB versus non-RCB classes ( Fig. 3 ). For example, in the pCR (complete response) components—taking the top five molecular features across different modalities revealed distinct molecular patterns. Specifically, gene expression analysis showed that downregulation of FBXO2 and RPS28P7 inhibits tumor cell proliferation, and potentially may enhance treatment efficacy, and the upregulation of C2CD4D-AS1, CSF3R, and SMPDL3B genes may promote immune response, increasing tumor cell vulnerability and therapeutic effect ( Fig. 3A ). Mutational analysis revealed negative associations of marker genes HMCN1 and GATA3, but a positive association for COL5A1 ( Fig. 3C ). Additionally, tumor mutation burden (TMB), and homologous recombination deficiency (HRD)-Telomeric AI signatures were higher in pCR patients, suggesting high genomic instability compared to RCB patients [ 9 ]. TiME analysis showed reduced immunosuppressive mast cells and extracellular matrix (ECM), along with increased infiltration of neutrophils, TIM-3 and CD8+ T-cells ( Fig. 3D ). Subsequently, the pathway analysis further revealed potential downregulation of the PDGFRB pathway, involved in stromal cell activity and associated with improved patient response [ 49 ], while upregulation of pathways for antimicrobial peptides, FLT3 signaling, ephrin B reverse signaling and potential therapeutics for SARS ( Fig. 3E ), suggesting enhanced immune surveillance and interaction with tumor cells. In summary, MOMLIN reveals distinct genomic landscape with higher immune activity and genomic instability in pCR that characterizes its favorable treatment response.

Heatmaps illustrate the features importance on response-associated components identified by MOMLIN. Each row in the heatmap represents a drug-response class, pCR, RCB-I , RCB-II and RCB-III, with columns representing features across different data modalities. The color gradient indicates feature loading or importance, representing the strength of association with response classes. The sign (negative or positive) of gradient denotes the association directions to response classes. All results in the heatmaps depict an average over 100 runs of five-fold CV. (A–E) represents the response-associated candidate biomarkers detected in latent components in (A) gene expression data (highlighting DE genes), (B) clinical features, (C) DNA mutations (highlighting mutated genes), (D) TiME cells and (E) functional pathway profiles (highlighting altered pathways).

Similarly, in the RCB-I (good response) components—RNA expression analysis revealed that lower expression of genes GPX1P1 and HBB are linked to less aggressive tumors [ 48 ], while those of thiosulfate sulfurtransferase (TST), NPIPA5 and GSDMB were overexpressed, linked to enhanced immune response and therapeutic effectiveness [ 49 , 50 ]. Mutational analysis showed positive association for therapeutic targets signatures TP53, MUC16 and RYR2 [ 51 , 52 ], but a negative in NEB, and CIN scores. TiME analysis demonstrated increased infiltration of Tregs, cancer-associated fibroblast (CAF), monocytic lineage and natural killer (NK) cells, indicating more active of immune environment [ 9 ], with reduced TEM CD4 cells. Pathway analysis further identified downregulation of NOD1/2 signaling, EPHA-mediated growth cone collapse and toll-like receptor (TLR1, TLR2) pathways, involved in inflammation and immune response, with the upregulation of allograft rejection, and G0 and early G1 pathways. In summary, tumors that achieve RCB-I is marked by distinct genomics marker, active immune response, and lower CIN.

In RCB-II (moderate response) components: RNA expression analysis revealed overexpression of RPLP0P9, FTH1P20, RNF5P1 pseudogenes, following accumulation of overexpressed ERVMER34-1, and PON3 genes play an oncogenic role in BC [ 53 ]. Mutation analysis revealed positive association of HRD-LOH, RYR1 and MT-ND4, but negative association of MACF1 and neoantigen loads, in line with previous reports [ 54 , 55 ]. Analysis of TiME features demonstrated increased infiltration of IDO1 and TAP2, with reduced CTLA 4, NK cells and PD-L2 cells, indicating a less suppressive immune environment. Pathways analysis further revealed downregulation pathways of G1/S DNA damage checkpoints and TP53 regulation, highlighting DNA repair issues, with the upregulation of PDGFRB pathway, E2F targets and signaling by Hedgehog associated with cell proliferation. In summary, RCB-II patients display distinct genomics markers including pseudogenes, lack of suppressive immune environment and active proliferation.

In RCB-III (resistant) components: RNA gene expression analysis revealed lower expression of therapeutic target PON3, and FGFR4 [ 56 ], and flowed accumulation of lower expressed lncRNAc ENSG00000225489, ENSG00000261116 and RNF5P1. Mutation signature analysis identified a positive association of MT-ND1, but a negative association in therapeutic targets TP53, and MT-ND4 [ 7 , 52 ]. Neoantigen loads were higher following lower TMB indicate reduced tumor suppressor activity. TiME analysis revealed reduced activity of T-cell exclusion, and HLA-E, with increased ECM, HLA DPA1 and LAG3, suggesting an immune suppressive tumor environment. Pathway analysis revealed upregulation of pathways involved in neurotransmitter release, cell-cycle progression (RB-1) and immune system diseases, suggesting active cell signaling and proliferation, with downregulation of EPHB FWD pathway and nucleotide catabolism. In summary, patients that attained RCB-III, characterized by low mutational burden and an immune suppressive environment, leading to treatment resistance.

Linking biology to treatment response through biomarker network analysis

To further extract multimodal network biomarkers and understand the complex biological interactions in patients with pCR and RCB, we performed cross-interaction network analysis using candidate signatures identified by MOMLIN across different modalities. This analysis included clinical features, DNA mutations, gene expression, TiME cells and enriched pathways, aiming to elucidate the underlying biology associated with specific treatment responses. Figure 4 shows the interaction networks of selected multimodal features for each RCB class. To identify potential biomarkers associated with pCR and RCB response, we specifically focused on the top ten multimodal features based on network edge connections. For example, tumors that attained in pCR, the network analysis revealed co-enrichment of mutations in HMCN1 and COL5A1 genes, particularly in estrogen receptor (ER)-negative patients. HMCN1 and COL5A1 therapeutic targets like molecules encode proteins for ECM structure, and mutations of these genes regulate tumor architecture and cell adhesion, potentially facilitating immune cell infiltration [ 52 ]. We also observed elevated expressions of FBXO2, CSF3R, C2CD4D-AS1 and RPS28P7 genes, alongside increased infiltration of CD8+ T-cells [ 9 , 57 ]. FBXO2 is a component of the ubiquitin-proteasome system, which regulates protein degradation and influences cell cycle and apoptosis [ 58 ], while CSF3R plays a vital role in granulocyte production and immune response [ 59 ]. These gene expression patterns, coupled with increased CD8+ T-cell infiltration, suggest a robust anti-tumor immune response. Furthermore, these molecular perturbations may be linked to antimicrobial peptide pathways and FLT3 signaling, potentially contributing to the favorable outcome in achieving pCR [ 60 , 61 ]. Future work could specifically search for these complex interactions across different molecules to gain more clinically relevant insights into pCR tumors. Supplementary Table S3 available online at http://bib.oxfordjournals.org/ presents the more detailed list (top 30) of the multi-modal and -omics biomarkers identified using the MOMLIN pipeline.

Multimodal network biomarkers explain drug-response classes. The multimodal networks detail the candidate biomarkers and their interactions for each response class, (A) the pCR patients (B) the RCB-I patients (good response), (C) the RCB-II patients (moderate response) and (D) the RCB-III resistance patients. Nodes in the network represent candidate biomarkers derived from clinical features, DNA mutations, gene expression, enriched cell-types and pathways, each indicated in different colors in the figure legend. Negative edges are light green; positive edges are in light magenta. Edge width reflects the strength of the interaction between features. Node size corresponds to the number of connections (degree), and the font size of node labels scales with degree centrality, highlighting the most interconnected biomarkers.

Similarly, RCB-I tumors exhibited co-enriched mutations in MUC16 and TP53, particularly in HER2+ cases [ 14 ]. MUC16 (CA125) is therapeutic molecule associated with immune evasion and tumor growth [ 51 ], while TP53 mutations can lead to loss of cell cycle control and genomic instability [ 62 ]. We also observed elevated expression of TST involved in the detoxification processes and GPX1P1 [long non-coding RNA (lncRNA)] involved in oxidative stress response. The immune landscape of these tumors showed increased infiltration of TEM CD4 cells (adaptive immunity), monocytic lineage cells (phagocytosis and antigen presentation) and NK cells (innate immunity), as well as CAFs. This immune landscape, coupled with potential perturbations in the allograft rejection pathway, suggests an active but potentially incomplete immune response against the tumor, resulting in minimal residual disease.

RCB-II tumors had lower neoantigen loads compared to pCR, both in ER-negative and HER2+ patients. This reduced neoantigen load might contribute to a weaker immune response. Gene expression analysis showed elevated levels of specific lncRNAs, including FTH1P20 (associated with iron metabolism), RNF5P1 (potentially affecting protein degradation) and RPLP0P9 (involved in protein synthesis), along with ERVMER34-1, which can influence gene expression and immune response in BC patients. Numerous studies have underscored the key regulatory roles of lncRNAs in tumors and the immune system. Notably, increased expression of the immune checkpoint protein IDO1 negatively regulates the expression of CTLA-4, both known to modulate antitumor immune responses [ 63 ]. The combined effect of these molecular alterations suggests potential tumor survival mechanisms, including immune evasion and dysregulation of G1/S DNA damage [ 64 ] contributing to moderate residual disease.

In RCB-III tumors, we observed the reduced prevalence of TP53 and MT-ND4 mutations, typically associated with genomic instability and aggressive tumor behavior [ 51 ], coupled with a higher neoantigen load, suggesting an alternative mechanism (pathways) that drives tumor progression. Despite the higher neoantigen loads, increased expression of HLA-E immune checkpoints and T-cell exclusion in the tumor microenvironment hindered effective anti-tumor immune responses. Additionally, the low-expressed genes PON3, ENSG00000261116 (lncRNA) and RNF5P1 are involved in detoxification, gene regulation and protein degradation, respectively, represents an adaptive response to cellular stress in these tumors. Clinical markers indicating lymph node involvement suggest a more advanced disease state [ 9 ]. These findings, along with potential perturbations in the neurotransmitter release cycle pathway, collectively portray RCB-III tumors as genetically unstable, yet effectively evading immune surveillance, contributing to their significant treatment resistance. Overall, further investigation of these interactive molecular networks, comprising both positive and negative interactions offers a more depth understudying of these potential candidate biomarkers for distinguishing treatment-sensitive pCR and resistant RCB tumors.

The advent of multi-omics technologies has revolutionized our understanding of cancer biology, offering unprecedented insights into the complex molecular interactions that shape tumor behavior and treatment response. In this study, we presented MOMLIN (multi-modal and -omics ML integration), a novel method to enhance cancer drug-response prediction by integrating multi-omics data. MOMLIN specifically utilizes class-specific feature learning and sparse correlation algorithms to model multi-omics associations, enables the detection of class-specific multimodal biomarkers from different omics datasets. Applied to a BC multimodal dataset of 147 patients (comprising RNA expression, DNA mutation, tumor microenvironment, clinical features and pathway functional profiles), MOMLIN was highly predictive of responses to anticancer therapies and identified cohesive multi-modal and -omics network biomarkers associated with responder (pCR) and various levels of RCB (RCB-I: good response, RCB-II: moderate response and RCB-III: resistance).

Using MOMLIN, we identified that pCR is determined by an interactive set of multimodal network biomarkers driven by distinct genetic alterations, such as HMCN1 and COL5A1, particularly in ER-negative tumors [ 9 , 65 ]. Gene expression signatures, including FBXO2 and CSF3R were associated with the immune cell infiltration (CD8+ T-cells), which has been previously reported as a key determinant of response [ 57 ]. The association of these biomarkers with antimicrobial peptide and FLT3 signaling pathways suggests a robust immune response [ 61 ] as a critical driver of complete response. Additionally, C2CD4D-AS1, an lncRNA was identified, and its exact role with these complex molecular interactions in BC remains to be elucidated. Future work could specifically search for these complex interactions across different molecules to gain more clinically relevant insights into pCR tumors.

RCB-I tumors, despite responding well to response, were associated with a distinct multimodal molecular signature. These tumors were enriched for mutations in the therapeutic target MUC16 (CA125), known for its role in immune evasion [ 51 ], and the tumor suppressor gene TP53, particularly in HER2+ cases [ 14 ]. Elevated expression of TST and GPX1P1 (lncRNA involved in oxidative stress response) were associated with increased infiltration of diverse immune cells, including Tem CD4+ cells, monocytes and NK cells [ 10 ]. This active immune landscape and the intricate interactions of these signature with the potential perturbations in the allograft rejection pathway, suggests a robust yet potentially incomplete anti-tumor immune response, contributing to the minimal residual disease observed in this subtype.

RCB-II tumors showed lower neoantigen loads compared to pCR, which could contribute to a weaker immune response, particularly in ER-negative and HER2+ subtypes. Increased expression of lncRNAs, such as FTH1P20, RNF5P1, RPLP0P9 and ERVMER34–1, were associated with the immune checkpoint protein IDO1, and negatively regulate the CTLA-4 protein expression, suggests immune evasion and alterations in tumor cell metabolism and proliferation. These molecules altered intricate interactions implicate dysregulation of G1/S DNA damage as a possible mechanism for moderate treatment response [ 64 ].

RCB-III tumors, classified as resistant, were associated with a distinct multimodal molecular landscape driven by reduced TP53 and MT-ND4 mutations [ 52 ], accompanied with higher neoantigen loads compared to other response groups. This suggests an alternative mechanism driving tumor progression and immune evasion. Despite the high neoantigen load which could potentially trigger immune response, these tumors exhibited immune evasion through increased HLA-E immune checkpoints and T-cell exclusion [ 40 , 55 ]. Also, the downregulation of genes like PON3 and the lncRNA ENSG00000261116, along with lymph node involvement, pointed to advanced disease and cellular stress adaptation [ 9 ]. The presence of these complex interactions, including potential perturbations in the neurotransmitter release cycle pathway, could contribute to treatment resistance in RCB-III tumors. Future studies targeting these immunosuppressive mechanisms and exploring novel pathways could offer promising avenues to overcome resistance in this aggressive subtype.

These findings above emphasize the potential of MOMLIN to enable deeper understanding of complex biological mechanism correspondence to each response class, ultimately paving the way for personalized treatment strategies in cancer. MOMLIN also demonstrated the best prediction performance for unseen patients by utilizing these identified sets of network biomarkers. By identifying response-associated biomarkers, researchers can stratify patients based on their likelihood of achieving pCR or experiencing RCB to anticancer treatments, facilitating more informed treatment decisions and potentially improving patient outcomes. Moreover, the identified biomarkers could serve as valuable targets for the development of novel therapeutic interventions and new biological hypothesis generation. However, the clinical translation of multimodal biomarkers necessitates addressing the potential economic burden associated with multi-omics testing. Developing targeted biomarker panels and prioritizing key hub molecules from the large-scale candidate multimodal network biomarkers identified by MOMLIN could be a viable strategy for reducing costs while maintaining predictive accuracy. Furthermore, ongoing advancements in sequencing and diagnostic technologies are expected to make multi-omics testing more accessible and affordable over time.

In conclusion, our study demonstrates MOMLIN’s capacity to uncover nuanced molecular signatures associated with different drug-response classes in BC. By integrating multi-modal and -omics datasets, we have highlighted the complex interplay between genetic alterations, gene expression, immune infiltration and cellular pathways that contribute to treatment response and resistance. Future research in this direction holds promise for refining risk stratification, optimizing treatment selection and ultimately improving patient outcomes.

While MOMLIN demonstrates promising results as shown, a key limitation lies in its reliance on correlation-based algorithms for multi-omics data integration. These algorithms are great at identifying associations, but they can fall short when it comes to inferring causality between different omics layers. This is a challenge faced by most current state-of-the-art methods [ 28 , 30 ]. In the future iterations of MOMLIN, we aim to incorporate causal inference methodologies alongside sparse correlation algorithms to better understand the complex causal relationships within multi-omics datasets.

We proposed MOMLIN, a novel framework designed to integrate multimodal data and identify response-associated network biomarkers, to understand biological mechanisms and regulatory roles.

MOMLIN employed an adaptive weighting for different data modalities and employs innovative regularization constraint to ensure robust feature selection to analyze high-dimensional omics data.

MOMLIN demonstrates significantly improved performance compared to current state-of-the-art methods.

MOMLIN identifies interpretable and phenotype-specific components, providing insights into the molecular mechanisms driving treatment response and resistance.

We thank Dr Yoshihiro Yamnishi and Mr Chen Yuzhou for their technical help.

This work was supported by the core research budget of Bioinformatics Institute, ASTAR.

Supplemental information and software are available at the Bib website. Our algorithm’s software is available for free download at https://github.com/mamun41/MOMLIN_softwar/tree/main

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In Abortion Cases, Legions of ‘Friends’ Seek to Persuade Supreme Court

A new study analyzed 50 years of friend-of-the-court briefs and found that abortion opponents were more relentless than their adversaries, with some reflected in the justices’ opinions.

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By Adam Liptak

Reporting from Washington

When the Supreme Court decided Roe v. Wade in 1973, establishing a constitutional right to abortion, it noted that it had received 14 friend-of-the-court briefs and listed them in a snug footnote at the beginning of the decision.

By 1992, when the court reaffirmed Roe’s core holding in Planned Parenthood v. Casey, the number of such filings, which lawyers call amicus briefs, had swelled to more than 30, and the footnote reciting them had grown unwieldy, taking up more than a page .

In the decision that overturned Roe in 2022, Dobbs v. Jackson Women’s Health Organization, the court was flooded with more than 140 amicus briefs . The footnote had metastasized, spanning seven pages.

Those 50 years of amicus briefs tell a cumulative story, one explored in a new study published in The Missouri Law Review , “The Rhetoric of Abortion in Amicus Briefs.” Using corpus linguistics, a social-science tool that analyzes patterns of words in large databases, the study found that the briefs “serve as a barometer revealing how various constituencies talk about abortion, women, fetuses, physicians, rights and harms over time.”

The study, conducted by Jamie R. Abrams , a law professor at American University, and Amanda Potts , who teaches at Cardiff University, concluded that opponents of abortion had in some ways been more effective, remaining “resolutely intent on advancing fetal personhood.” The anti-abortion briefs were nimble, they wrote, and were “able to adapt and evolve in response to doctrinal shifts of the court.”

Overall, the authors wrote, abortion opponents had pressed “a more relentlessly human, emotional, personal attack to pursue its political agenda.”

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Texas' anti-abortion heartbeat law aimed to save babies, but more infants died.

Texas lawmakers touted their heartbeat law as an effort to save lives , but the state's near-total ban on abortion appears to have triggered an increase in infant deaths, according to a new study published Monday . 

The findings in JAMA Pediatrics show that infant deaths rose after Texas’ Senate Bill 8, which banned all abortion after about six weeks from conception. S.B. 8 became Texas law in September 2021 and U.S. Supreme Court overturned the constitutional right to abortion just over nine months later, on June 24, 2022. The high court ruling in the Dobbs case prompted more than a dozen states to issue near-total bans on abortion. Observers speculate that evidence will also show increases in infant deaths in those states, akin to what Texas has seen, the study said.

“It just points to some of the devastating consequences of abortion bans that maybe people weren't thinking about when they passed these laws,” Alison Gemmill, an assistant professor at Johns Hopkins University’s Bloomberg School of Public Health who authored the study, told USA TODAY. She called the deaths following the Texas heartbeat law its “spillover effects on moms and babies.”

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In the wake of the law's passage in Texas, more babies died before their first birthday, likely due to birth defects or genetic problems that wouldn't have allowed them to live, the study found. These pregnancies would typically have been terminated by abortion, according to researchers. The Texas heartbeat law does not provide exceptions for pregnancies involving such conditions. Mothers are legally obligated to carry these babies to birth under state law.

In the peer-reviewed Journal of the American Medical Association, Gemmill and researchers from Johns Hopkins and Michigan State University wrote that the Texas law was linked to "unexpected increases in infant and neonatal deaths" between 2021 and 2022. Prior research drew a correlation between the uptick in infant deaths and anti-abortion laws taking effect, however, no studies until now have attributed the fatalities directly to the laws prohibiting the termination of these pregnancies.

"Abortion care is an essential component of comprehensive healthcare, and when it is restricted, the human impacts are devastating," Wendy Davis, a senior adviser for Planned Parenthood Texas Votes, said in a statement. Davis, who filibustered for abortion rights when she was a Democratic state senator, noted that the study only covered 2022, not the results in 2023 and 2024 in the wake of a more restrictive abortion ban that came with the Dobbs decision. This "likely means the situation on the ground today is even more dire," Davis said.

Texas Gov. Greg Abbott's office did not dispute the study's findings but defended the Republican-controlled state's anti-abortion record. This effort included the 2021 heartbeat law "to save the innocent unborn, and now thousands of children have been given a chance at life," Andrew Mahaleris, a spokesperson for Abbott, said in a statement to USA TODAY. He said the governor has taken "significant action to protect the sanctity of life" and offered resources to expectant mothers "so they can choose life for their child."

Anti-abortion advocates also didn't contest the uptick in infant deaths cited in the study. Advocates for the heartbeat law and other legislation to restrict abortions say such bans protect life. They say terminating a fetus with a terminal illness is “choosing to kill that child intentionally.”

The overwhelming majority of such abortions happen before the fetus is viable. In Texas, legislation has dramatically reduced the number of abortions performed in the state.

Amy O’Donnell, a spokesperson for Texas Alliance for Life, said the study’s findings didn’t come as a surprise. She said babies born with disabilities and even fatal anomalies deserve a chance at life, even if that means a newborn dies after birth from a condition doctors anticipated would be lethal. The death of a child is not easy, she acknowledged. She noted that her nonprofit offers resources for families grieving from such losses.

“In Texas, we celebrate every unborn child's life saved. We treasure the fact that our laws are protecting women's lives,” she said. “We don't apologize for the fact that we don't support discrimination against children facing disabilities or fatal diagnoses in or out of the womb. And that's the line that we just believe should not be crossed.”

Gemmill, of Johns Hopkins, said babies that died shortly after being born with birth defects "probably caused a lot of unnecessary trauma to families."

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The researchers examined death records beginning after the heartbeat law went into effect. The study created a “synthetic Texas” that simulated outcomes that would have happened had the law not been in effect and compared the numbers to national trends during that period. In 2021, 1,985 Texas infants died before their first birthday. The next year, with S.B. 8 in effect, the fatalities jumped to 2,240, a 12.9% increase that came as the U.S. experienced an overall increase of less than 2%. Deaths attributable to congenital anomalies or birth defects spiked nearly 23% in Texas compared to a 3% decrease nationally.

“It suggests that, really, this policy was responsible for this increase in infant deaths in Texas,” Gemmill said.

The study is significant because of Texas’ role as a conservative state with urban and rural areas that may reflect what happens in the rest of the U.S., according to Dr. Tracey Wilkinson, an associate professor of pediatrics and obstetrics and gynecology at the Indiana University School of Medicine. Texas has been living under restrictions longer than other states that enacted abortion bans after the Dobbs ruling.

“When people ask me why this is happening, it’s really simple,” said Wilkinson, who was not involved with the new study. “When you take away people’s ability to make decisions (about) if and when they have pregnancies, you’re going to see outcomes like increasing infant and maternal mortality.”

The study did not examine the effects of infant deaths on the health of mothers who were legally required to deliver dead babies to term, nor did it look at the mental health effects of carrying infants and delivering them, only to see them die. The study also raises but does not tackle questions about the financial cost to families of carrying and delivering terminally ill newborns. 

Gemmill is now working to understand the impact of abortion restrictions on parents of different races and ethnicities. Prior research has shown that Black mothers and babies face higher death rates than other groups.

The study reflects what Molly Duane, a senior staff attorney at the abortion rights advocacy nonprofit Center for Reproductive Rights, has seen in the courtroom arguing against Texas' laws. She recently represented women who sued the state after they were denied medical abortions. One of her clients, Samatha Casiano, was required by law to carry a child that developed without a brain. In late May, the Texas Supreme Court ruled pregnant patients must have a “life-threatening condition” in order to terminate a pregnancy.

Duane questioned the claim by anti-abortion activists that Texas is a “pro-life” state, given the study's findings. “Women are hurting, families are hurting, babies are dying, and no one in the state is taking responsibility for any of that real human suffering,” she said.

In late 2023, a U.S. Centers for Disease Control and Prevention report found increases in infant deaths for the first time in more than 20 years. The states identified in the report with increased fatalities were states that restricted abortion access, however, experts cautioned at the time that they could not say what had caused the spike in fatalities.

The Texas study went one step further, finding one state where abortion restrictions resulted in more deaths.