For Daniel Callahan, the acceptance of voluntary active euthanasia and physician-assisted suicide minimally requires that the physician fulfilling or denying the patient's request have her own moral grounds for helping (or refusing to help) a patient to die.
While I share Wolf's concern for the way in which the debate over euthanasia and physician-assisted suicide has been decontextualized and governed by an individualistic model, I believe that contextual considerations should lead us to question why women's death requests are taken less seriously and acted on less often than those of men.
A person's access to euthanasia and physician-assisted suicide should not be affected by conditions over which she has no control: it is alarming to think that in a sexist society, only some members' claims to pain and psychic suffering will be taken seriously.
To establish the moral equivalence of active euthanasia and physician-assisted suicide, two strategies are possible: showing that the same arguments that purport to justify physician-assisted suicide would also justify active euthanasia, or showing that objections to active euthanasia would count equally against physician-assisted suicide.
Since we are unable to distinguish morally between active euthanasia and physician-assisted suicide in terms of their consequences, we need to look elsewhere to support the distinction.
There is another reason why the causal distinction between active euthanasia and physician-assisted suicide does not support a moral distinction.
Supporters of physician-assisted suicide who oppose active euthanasia could concede that physicians play a major causal role in and share responsibility for the patient's death in physician-assisted suicide, but nonetheless insist that the relatively minor difference in the physician's causal role in active euthanasia and physician-assisted suicide is crucial.
Neither one of them succeeds in showing that physician-assisted suicide would be justifiable, and any moral wedge that they create between active euthanasia and physician-assisted suicide is insignificant.