Background: Post-trial access (PTA) is an important element of any ethics or regulatory guidance document. It was first introduced in the Declaration of Helsinki (DoH) in the year 2000 but has only recently gained momentum. The objective of this narrative review was to examine the evolution of PTA in Indian bioethical and regulatory guidelines. Methods: Websites of all Indian government agencies that issue ethics guidelines periodically as well as the website of the Indian regulator was searched by three authors and the guidelines downloaded. Identification of PTA in the guidelines was done by all authors and a consensus was reached. The Scale for the Assessment of Narrative Review Articles (SANRA) criteria were used as the reference framework. Results: The Indian Council of Medical Research (ICMR) guidelines of 2000 and 2006 mention PTA, though the most comprehensive coverage can be seen in the 2017 ICMR guidelines. This was followed by a good coverage of PTA in the New Drugs and Clinical Trials (NDCT) rules of 2019. Other guidelines have also briefly alluded to PTA. Conclusion: In the years to come, Indian guidelines must evolve beyond PTA towards post-trial provisions (as introduced in DoH, 2024) or post-trial care, which are broader in their vision and go beyond the individual participant in a clinical trial.

In the governance of healthcare, medical ethics is fundamental to ensuring transparency and protecting patient rights. Medical dramas are increasingly shaping public perception of medical themes, fuelling public debate on medical ethics. In this reflective piece, we examine how three popular Hindi web series, Human (2022, Disney+Hotstar), Pill (2024, Jio Cinema), and Kaala Paani (2023, Netflix) explore critical issues, such as clinical trial ethics, medical litigation, and epidemic response management. Although these narratives raise public awareness, they often dramatise complex regulatory frameworks, which can lead to the misinterpretation of real-world medical practice. We evaluate how these portrayals align with real-world bioethics and healthcare regulations, assessing entertainment media's dual capacity to inform public understanding and potentially mislead audiences about critical ethical dilemmas in the Indian healthcare landscape.

Medical students encounter patient deaths throughout their training and tend to cope with death under the pretence of curing to fight off the imminence of death, rarely pondering the true meaning of mortality. This assumed numbness often makes them harsh, insecure, and somehow oblivious to the human plight of patients and their families. The Covid-19 pandemic has made the need for reflection on mortality even more significant. This commentary discusses a cemetery visit as part of the clinical ethics training of medical students. On this “existential trip”, students address their perceptions, fears, and beliefs about death and dying, opening their eyes to the reality of the profession of medicine. This form of experiential learning aims to awaken students to the inevitable fate they share with their patients, dispelling the illusion of being infallible physicians, thus helping shape empathetic future physicians sensitised to the unuttered distress of dying patients and their caregivers.

In this personal essay, I recount my lived experience of childhood tuberculosis, highlighting the physical, emotional, and psychological toll on myself and my family. I reflect on how tuberculosis care has since improved, but also how certain critical gaps persist, especially the challenges of inadequate financial support, post-recovery social reintegration, and insufficient psychological care for persons with tuberculosis. Drawing from my experience, I advocate measures to address stigma, invisible costs, and discrimination. Holistic care for tuberculosis must go beyond just medical recovery and ensure dignity and meaningful social healing for all.

Congenital Diaphragmatic Hernia (CDH) is usually diagnosed prenatally. Despite advances, the prognosis remains poor for severe CDH in many healthcare settings, and many require transition to palliative care. This transition can be an ethical dilemma especially in cases of conflict between stakeholders. A resolution can be accomplished with clinical ethics consultations, but these are rarely available in India. This case report describes how such ethical dilemmas can be resolved by applying paediatric ethics principles in conjunction with Jonsen’s four-box model.

The World Health Organization (WHO) released a draft guidance on clinical ethics in May 2025. This document covers education and capacity building in clinical ethics, the setting up of clinical ethics services in institutions, and the development of policies to implement clinical ethics review at institutional, national and international levels. The guidance is promising, but there are important contextual issues in India, raising concerns about its adoption and effective implementation. From the experience with research ethics committees, we know that despite more than a decade of mandating ethics committee review of medical research, we still face a number of challenges. The same practical issues will likely plague the operations of clinical ethics committees. We need to learn from and adapt learnings from these experiences. Clinical ethics rounds could offer an important model to be considered in the hospital setting. However, a large part of primary healthcare is delivered in the community. Clinical ethics considerations also arise at the intersection of a pluralistic medical practice milieu in India, and in diagnostic laboratory and imaging services and allied healthcare services like physiotherapy and occupational therapy. Clinical ethics review must include all of these. Patient advocacy groups, and civil society organisations act as watchdogs against medical malpractice and are important stakeholders in the clinical ethics review process. Media reports also play a crucial role. The role of these stakeholders must be given due importance in the guidance for it to realise its full potential to initiate discourse and strengthen clinical practice regulation in India.