A federal judge who ordered doctors at Walter Reed Army Medical Center last week to honor a cancer patient's wish to die has said that it is "the patient, not the physician, who ultimately decides if treatment -- any treatment -- is to be given at all."

U.S. District Judge Thomas Penfield Jackson overruled Army policy last week by granting a petition from the patient, Martha A. Tune, 71, of Falls Church, to be disconnected from life-support equipment.

Tune died about six hours after doctors, obeying the court order, removed a respirator tube supplying oxygen to her.

Tune's request was not opposed in court by government lawyers or the Army, but Jackson's decision has caused "some gnawing and gnashing of teeth" at the Pentagon, according to one official.

The source said some senior Army officials believed that they should have been consulted before a decision was made that the government would take no position on whether Tune should be permitted to die.

An Army spokesman said yesterday a review of the service's policy on removing life-support equipment in military hospitals is under way in light of Jackson's ruling.

The policy permits Army doctors to withhold life-sustaining equipment at a patient's request, but it prohibits removal of such a system once it is in use.

Jackson's decision is the first in the nation applying to terminally ill patients in military hospitals. It establishes a precedent for cases in which the circumstances are identical, Assistant U.S. Attorney Royce C. Lamberth said. The ruling does not compel the same outcome outside the District of Columbia, Lamberth said, but it is certain to be cited by other federal judges facing the same issue.

In a memo made public yesterday, Jackson said the Supreme Court has not ruled on the "primacy of individual autonomy" regarding the issue of natural death.

Jackson cited the high court's historic 1974 decision legalizing abortion, however, as "instructive for purposes of this case."

In that ruling, Roe v. Wade, Jackson said, the Supreme Court "proceeded upon the premise that a competent adult has a paramount right to control the disposition to be made of his or her own body, absent a compelling countervailing governmental interest."

Witnesses at last Thursday's hearing, including Tune's adult son, testified that Tune was mentally competent and had no doubts about her wish to "die a dignified and natural death."

"It is now a well-established rule of law," Jackson said, " . . . that it is the patient, not the physician, who ultimately decides if treatment -- any treatment -- is to be given at all . . . .

"While preservation of life in the abstract is no doubt a transcendant goal for any society which values human life, the state's interest in maintaining life must defer to the right to refuse treatment of a competent, emotionally stable, but terminally ill adult whose death is imminent . . . . "

Such a patient, said Jackson, "is, therefore, the best, indeed, the only, true judge of how such life as remains to him may best be spent."