Summary This paper considers how matters concerning value pluralism and moral diversity bear on issues in bioethics, with particular attention to methodology, moral reasoning, and the possibility of intractable disagreements. Drawing on work in my recent book Moral Reasoning in a Pluralistic World, I examine what methodological implications value pluralism has for coherence reasoning, then articulate some practical implications. On the theoretical side, I argue that in contexts of value pluralism, a norm of “systematicity,” which says that the principles of a theory should be as few and as simple as possible, is epistemologically unsupported. Instead, coherence should be understood as “case consistency”: finding a principled way of prioritizing conflicting considerations from one case to another. On the practical side, adopting case consistency means that multiple internally coherent sets of moral beliefs are possible. So sometimes deep value-based disagreements cannot be resolved by reasoning alone. There are also implications for pedagogy: if moral reasoning accommodates various values and requires principled compromises that can take various forms, teaching about moral issues by first introducing a range of unified theories would not be the right approach. Instead, students ought to be encouraged to bring coherence to their own, possibly pluralistic, ways of valuing.