The concept of “fitness to stand trial” must be viewed as an aspect of the broader notion of fair trial which is rooted in the idea that whenever the accused, for reasons of ill health, is unable to meaningfully exercise his or her procedural rights, 1 the trial cannot be fair and is in contravention to Article 21 of the Constitution. This article analyses the prevailing framework in India governing the aspect of fitness to stand trial of the accused. To strengthen the Indian framework, recourse is taken to the prevailing international standards. The article suggests a reform centric approach to streamline the criteria for fitness determinations. Recommendations within the scheme of the Indian law include the shift from a prima- facie based criteria to a treatability approach to determine the postponement or discharge of the trial qua the accused. Furthermore, the expert report relied upon by the magistrate to determine unfitness, should be conclusive. To add to the conclusiveness of the report, reflecting on international standards, proposals such as examination by a multi-disciplinary board of experts, transparency in expert reports are provided. These reforms will lead to comprehensive assessments tailored to the specific needs of each accused individual when it comes to assessing the criteria for meaningful participation in a trial. The necessity to strike the delicate balance between the rights of the accused and the rights of victims underscores the complexity of assessing fitness to stand trial within the Indian legal system. This article critiques the limitations of the current Indian framework, particularly the reliance on prima facie criteria, and advocates for a reform-centric approach inspired by international standards like the Strugar factors and Nahak rationality. The proposed reforms emphasize a treatability-based assessment, multidisciplinary expert boards, and transparency in expert reports to strike a balance between the rights of the accused and victims, ensuring justice delivery in line with the new criminal law reforms. By incorporating these suggestions, India with the enactment of BNSS can uphold the principle of fairness and tread the path of pragmatism with respect to fitness to stand trial of the accused.