Since Canada legalized medical assistance in dying (MAID) in 2016, it has become one of the most permissive regimes in the world for euthanasia and assisted suicide. The number of deaths has risen rapidly and the categories of eligibility continue to expand. The country is poised, as of March 2024, to allow MAID for those whose sole underlying condition is mental illness, generating considerable debate. Advocates of MAID for mental illness often frame it as a question of equal access, but this extension involves considerable complexities not present in other cases. This paper examines psychiatric MAID in the Canadian context, engaging directly with the most pertinent arguments of the practice’s advocates. The paper argues that independent of any prior commitments vis-à-vis the permissibility of MAID per se, there is a clear ethical and legal necessity to oppose extending MAID on the grounds of mental illness if we follow the parameters set up within the Canadian regime. The paper advances three arguments: first, that mental illnesses cannot be deemed irremediable, as required by the Canadian law; second, that we cannot establish with adequate certainty that a mentally ill patient has the decision-making capacity to choose MAID; and third, that allowing psychiatric MAID will have a devastating impact on care and support of the mentally ill.