You can do it from either the 68k or the SH2. They can both access the 32x VDP registers and framebuffer but at different addresses (and only one side can claim the bus at a time). But before that, you need to enable the 32x. If you look at 32x games you'll see the startup code which contains the string "MARS CHECK MODE". It's somewhat similar to the startup code for Genesis games, and likewise a bit obfuscated.
Look for Dr. DevSter's Guide to the Sega 32x. I can post my 32x cheatsheet too.