(279) Parental Authority, Adolescent Involvement, and the Ethics of Male Circumcision in Minors: A Bioethics Scoping Review

Introduction Male circumcision of minors remains one of the most widespread irreversible bodily procedures performed globally, often before children are capable of understanding, consenting, or expressing their preferences. While medical, religious, and cultural traditions continue to justify the practice, non-therapeutic circumcision raises pressing ethical questions, particularly concerning autonomy, bodily integrity, and the scope of parental authority. Although parents have historically held broad decision-making power over their children’s healthcare, contemporary bioethical frameworks increasingly emphasize the evolving capacities of minors and the moral obligation to defer non-essential irreversible procedures until a child can meaningfully participate in the decision. The ethical debate is further complicated by global diversity in cultural norms, legal structures, and public health narratives, including efforts to promote circumcision for HIV prevention in certain regions. Objective This scoping review aimed to synthesize current empirical and ethical literature on how parental authority, adolescent involvement, and cultural narratives shape the decision to circumcise male minors. Specifically, the review examined how parents justify circumcision, the extent to which adolescents participate in decision-making, and how clinicians and communities negotiate tensions between cultural identity and child autonomy. Methods A scoping review methodology was employed in accordance with PRISMA-ScR guidelines, with protocol registration and approval in PROSPERO. Eight electronic databases (MedLine, Web of Science, Scopus, ProQuest, Springer Nature Link, EBSCO, SAGE, and Taylor & Francis) and grey literature sources were systematically searched. A total of 401 records were identified, 131 duplicates removed, and the remaining articles screened independently by two reviewers, with disagreements resolved by a third. Twenty-nine studies published between 1998 and 2024 met the inclusion criteria. Data were extracted and synthesized across cultural, legal, ethical, and decision-making dimensions. Results Across the studies, decisions regarding circumcision were overwhelmingly made by parents or guardians, with only three studies reporting meaningful involvement of adolescents in consent or assent processes. The most common justifications for circumcision included cultural identity, religious obligation, perceived hygiene benefits, and, in sub-Saharan Africa, HIV prevention. However, in both medical and community-based settings, adolescents frequently reported limited understanding, indirect or direct pressure from family or community, or lack of opportunity to refuse. Public health circumcision campaigns sometimes introduced additional ethical concerns, including inadequate counseling, insufficient verification of parental consent, and incentivized recruitment. In ritual and traditional contexts, circumcision frequently symbolized social belonging and the transition to manhood, often overriding consideration of the child’s bodily autonomy. Several studies also documented parental regret, intra-family disagreement, or moral discomfort among clinicians performing non-therapeutic circumcision. Conclusions These findings illustrate a persistent ethical tension: while circumcision is often framed as beneficial or necessary within cultural or public health contexts, current practices commonly exclude minors from participation in decisions that permanently alter their bodies. Strengthening ethical safeguards, including standardized consent and assent procedures, improved counseling, and recognition of minors’ evolving autonomy is critical. Policymakers and clinical practitioners should work toward culturally sensitive, rights-respecting approaches that protect bodily integrity while acknowledging the significance of tradition and identity. Disclosure No