This chapter traces the long legal journey towards the recognition of advance directives (ADs) in India and contextualises these within the initial obstacles as well as the mitigating forces. The issues span the legalisation of passive euthanasia, the decriminalisation of attempted suicide and the eventual recognition of the right to privacy in India in 2017, as well as the development of psychiatric advance directives under the Mental Healthcare Act 2017. These developments culminated in the guidelines of the Supreme Court of India in the case of Common Cause v. Union of India in March 2018, which contain complex and lengthy procedures and requirements. We argue that the issues arising through these developments, as well as a number of cultural and religious influences, need further review. In particular, we focus on the role of family in end-of-life decision-making, and argue that in the law commission reports as well as in court decisions, courts and medical professionals have been represented as protectors of the patients from their families. As far as the practice of ADs is concerned, we present our survey results, which demonstrate a lack of awareness regarding advance directives.