Starting with a particular case of familial care for the aging, the discussion points to the difficulties in deriving practical judgments from ideal theory in cases where there seems to be injustice, but where there are multiple competing dimensions of value and cost. The essay argues that the problems discussed are deeply embedded in modern western cultures, where life expectancy has risen dramatically and has been coupled with a range of other social and demographic changes that make familial care for the aged difficult and burdensome, and where our thinking about justice and rights are integral to the conflicted ways in which people construct and experience these situations, rather than standing independently as a solution to them. The essay argues for a set of partial, limited, and “realist” responses that reduce some elements of burden, without pretending to provide a solution that is in any sense ideal or wholly just. The argument from a case is integral to the essay’s case for realism in moral and political philosophy.