I think they would. Suppose you extract the transplantable organs of a dead patient without permission, is it ethical? Have you harmed the patient? If the relatives don't find out, are they harmed?
But people have the choice of wether to live in that country or not. And citizens have the means to elect a new government to change that law. Because people that live in Spain know that the default is opt-in (or at least have the opportunity to find out), they have made a choice to either allow, or not allow organ harvesting. So, yes, removing the organs of someone who has not consented is unethical, regardless of the locale.
Spain (and many other countries) decided that they would rather be opt-out, so by default you've consented. This is actually a great example of the power of defaults to affect an outcome. Because of this out-out, the number of donations increases significantly.
I'd be more interested to know what happens to foreigners. I suspect that they aren't treated as consenting, but I don't know.
This goes to the definition of "ethical", and it's distinct from "moral", in the sense that ethics are a codified set of rules or guidelines: one does not judge something as ethical based on the result, but based on its conformity to a set of explicit or implicit expectations of conduct.
Ethics can be personal though, and there are many different forms, many of which explicitly focus on the result, and many which do not. I still think that it is very difficult to separate the concept of ethics from the notion of harm. Even where codified, the concept of avoiding harm, if only to members of your own clade for the more tribal forms, is pretty central to the formulation of pretty much all ethical systems.
I figured that was where they were going... but wanted to make sure - the word medic threw me.
"Do no harm" isn't as clear cut as that. You have to do harm all the time as a doctor - the question is what is the lesser harm? Would you rather have a few broken ribs, or a heart that isn't beating. Either way, you're causing harm. Most people would rather you crack a few ribs though.
(BTW, that phrase actually isn't part of the Hippocratic Oath [1][2])
Here's a different example. Is burning a religious text (Bible, Koran, etc...) ethical? What if it is in private? Is anyone harmed? Many people would consider this an unethical act, even if no one was around to see it. And if no one would see it (and thus be offended), where is the harm?
Another example: Imagine Alice is in a wheelchair and is shopping. She accidentally drops her phone on the floor. At that moment, Eve walks by, notices Alice struggling, and yet does nothing. Eve continues walking on her way. Did Eve cause Alice harm? Alice was already in trouble, and Eve didn't do anything help. However, Eve didn't do anything to cause Alice's problems. So you can't really claim that Eve harmed Alice, even though many would question her inaction.
This is just to point out that the concepts of harm and ethics aren't necessarily linked. But that is really moot in this case, because no one can really claim that this kid caused AOL no harm. It may just be really small in monetary terms.
[edit] And apologies for being unnecessarily obtuse earlier, one of the precepts for ethics in medicine is the phrase "First, do no harm", which is what I was obliquely blathering on about. So rather than being very different questions, the concept of harm is firmly tied to many of our concepts of ethical behaviour.
