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In societies organised around an imperative of suicide prevention, the expansion of assisted-dying legislation presents a clinical and ethical paradox: on what basis is a wish for death considered pathological in one context and reasonable in another? This paper argues that assisted dying and suicide, though often treated as psychologically equivalent, represent fundamentally different psychic configurations. Psychological processes matter because misunderstanding them, and mistaking a suicidal act for an assisted death, may lead to serious harm to patients, families, clinicians, and the integrity of clinical safeguards. Drawing on psychoanalytic theory, suicide research, bereavement studies, and international evidence, the paper proposes that the key distinction lies in the work of mourning. Suicide is conceptualised as a pre-mourning state in which unbearable affect is evacuated through acting out, often with traumatic consequences for survivors. Assisted dying, by contrast, may represent the culmination of a process in which mortality has been acknowledged, symbolised, and shared. Through clinical vignettes, bereavement outcomes, fluctuating desire for hastened death, and the physician’s symbolic and countertransferential role, the paper shows how these configurations may diverge and overlap. It concludes by proposing a mourning-informed clinical framework and outlining implications for supervision, multidisciplinary practice, safeguards, and future research.