Four years after a group of doctors sparked controversy for stunting the growth of a girl with severe disabilities, a panel now says the practice is “morally permissible” in some cases.

The 20-member working group composed of pediatricians, lawyers and philosophers in addition to family members and those with disabilities from across the country, debated what’s come to be known as the “Ashley treatment,” named for the 6-year-old who was given estrogen to limit her growth.

The treatment was initiated at the request of Ashley’s parents who said she would be easier to care for at a smaller size. What’s more, they said their daughter, who has not gained abilities mentally or physically past those of a three-month-old, would be more comfortable and less vulnerable to abuse if she did not mature sexually.

Though unable to reach a consensus, the group known as the Seattle Growth Attenuation and Ethics Working Group settled on what they call a “moral compromise” in their conclusions published this month in the bioethics journal, The Hastings Center Report.

Stunting a child’s growth can be “ethically acceptable” for those with “persistent, profound developmental and intellectual impairments,” they said. However, there should be safeguards in place and they say the practice should not be conducted simply because parents request it.

“The benefits and risks are similar to those associated with other decisions that parents make for their profoundly disabled children and about which reasonable people disagree,” they wrote, though not all members of the group agreed to the compromise.

In Ashley’s case, doctors gave the girl large amounts of estrogen to limit her growth from an expected 5-foot-4 to about 4-foot-6, a practice known as growth attenuation. In addition, doctors removed Ashley’s uterus and breast buds to prevent menstruation.

Word of Ashley’s experience went public after her doctors published a paper in the Archives of Pediatric and Adolescent Medicine in 2006, igniting a public debate. Some were sympathetic to Ashley and her parents, but others in the disability community were critical of the approach, which they compared to involuntary sterilization.