Based on long-term dialogues with people affected by drug resistant TB in India, this presentation maps key challenges to the protection of patient rights at various critical points on the pathway from onset of symptoms to XDR development, and relates these challenges to the recent WHO Ethics Guidance document. Porous boundaries between public and private treatment leading to out-of-pocket payment for diagnostics and treatment of poor patients with DRTB raise particularly difficult ethical questions in resource-poor settings.