The World Health Organization (WHO) released a draft guidance on clinical ethics in May 2025.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.