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The ethical and clinical dimensions of strabismus surgery in a case of an infant with mucolipidosis type II are discussed. Three sets of considerations are relevant to the decision of performing such surgery: professional obligations to protect patients from futile or contraindicated treatment; parental authority to assess the risks and benefits for elective pediatric care; and the role of the family as patient. We argue that, when weighed together in the context of this case, these considerations can support a decision to perform the surgery upon parental request, despite the patient’s poor prognosis.