“It was more comfortable than I could have imagined,” is how The Unit begins, with Dorrit, a single, impoverished 50-year-old woman picked up from her home in a metallic red SUV and transported to a luxury facility constructed by the government for people just like her. Her new, two-room apartment is bright and spacious, “tastefully decorated,” inside a complex that includes a theater, art studios, a cinema, a library, and gourmet restaurants. For the first time, Dorrit is surrounded by likeminded people and included rather than ostracized. At the Second Reserve Bank Unit for biological material, she’s one among a community of people who couldn’t—or didn’t want to—have children.

The cost is that, for the remaining four or five years of her life, Dorrit will be subjected to medical testing and will donate her organs one by one until her final, fatal donation. The Unit’s author, the Swedish writer Ninni Holmqvist, has imagined a society fixated on capital, but in human form. Those who have children or who work in fields like teaching and healthcare are seen as enabling growth; the childless and creative types like Dorrit, a writer, are deemed “dispensable,” removed, and forced to make their own biological contributions. The unit itself is a fantasy of government welfare for aging citizens (it offers delicious meals, culture, and companionship), but with a particularly sharp twist.

And yet one of the most jarring elements of the book is the extent to which all the residents not only accept but affirm their own status. “All this luxury! How much is all this costing the taxpayer?” Dorrit’s new friend Elsa remarks, aghast, when she sees the well-appointed exercise facilities. Dorrit reiterates over and over again that she lives in a democracy, where anyone has the right to express any opinion they want to. Though the idea for “biological reserve units” was first proposed by a fringe political party, she recalls, it soon “slipped into the manifestos of some of the bigger and more established parties,” and was ultimately passed by referendum. Holmqvist’s dystopia doesn’t emerge from autocracy but from widely held beliefs about the necessity of procreation, taken to an extreme.

Holmqvist wrote The Unit, she explains in an author’s note, after she turned 45, when it occurred to her that she was “completely dispensable,” and that her death would leave “no tangible empty space behind me that needed to be filled.” As a childless woman in a creative profession, she felt compelled to write about “how it felt to be regarded as a selfish, spoiled oddball who makes no contribution to any kind of growth.” The novel, first published in English in 2009, has been recently reissued, presumably to capitalize on the feverish interest in reproductive dystopias sparked by Hulu’s Emmy-nominated adaptation of The Handmaid’s Tale. But The Unit feels like an inversion of Margaret Atwood’s Gilead, where fertile women are forcibly impregnated under biblical sanction. Here, the justification for horror—the extraction of human tissue from the childfree—is secular, a capitalist democracy demanding its toll.

Holmqvist has a particular gift for pacing, withholding full explanation from the reader for as long as possible but proffering unsettling details from the very first page. Dorrit’s clean, light apartment is monitored in its entirety by cameras. Before the SUV arrives, she explains, she considered killing herself, but didn’t have the courage. There are no windows anywhere in the unit, which appears to exist inside some kind of dome. Internet use is allowed only under supervision, and when a five-course Italian meal is served for dinner, with Parma ham, melon, and panna cotta, “only the wine was missing.”

On her first night in the facility, Dorrit meets Majken, an artist who’s lived there for four years, and who’s donated “eggs for stem-cell research, one kidney, and the auditory bone from her right ear.” Soon, Majken explains, she’ll go in to donate her pancreas “to a student nurse with four kids. So I guess this will be my last welcome party.” Majken’s matter-of-fact tone and the general strangeness of her new situation prompts Dorrit to have a panic attack, and her three new friends comfort her. And as the novel progresses, the pattern continues, with Dorrit acclimatizing to the unit and comforting new residents in turn, just as she was soothed on her first day.

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The Unit contains elements that echo a number of different speculative and dystopian works. The domed environment and omnipresent cameras seem to predict Suzanne Collins’s The Hunger Games trilogy; the prospect of forcible organ donation brings to mind Kazuo Ishiguro’s Never Let Me Go, published in 2005, the year before The Unit was released in Sweden. Never Let Me Go, which tells the story of three clones raised from birth to be organ donors, ponders the humanity of genetic engineering. Holmqvist’s book, more provocatively, deals with the humanity of an ever-growing segment of the population: the childless. In her fictional society, the government has mandated 18 months of shared parental leave and free childcare for all children up to the age of 6. “There is no longer any excuse not to have children,” Dorrit states. “Nor is there any longer an excuse not to work when you have children.” The question of not wanting to do either doesn’t enter the equation; Dorrit knows, as all citizens do, that increasing the gross national product is the ultimate reason for her existence.

In this way, Holmqvist’s book functions better as a metaphor than as a warning. Practically, it isn’t necessary: There are, for instance, far more childless, “dispensable” citizens over 55 living in Europe today (at least several million) than there are people waiting for an organ transplant (63,000 in the entire European Union as of the end of 2013). A facility like the one Dorrit lives in would be prohibitively expensive to establish and maintain. But Holmqvist’s intention isn’t realism—it’s to unravel and critique assumptions about the meaning of life. Is it criminal, she wonders, to live a quiet life dedicated only to self-actualization? Do artists who never achieve greatness have value? Does every citizen have a responsibility to contribute to their society? In exploring such questions, Holmqvist takes liberal assumptions about Scandinavian paternalism versus American individualism and flips them upside down.

When Potter, an orderly, hints to Dorrit that he thinks the facility is morally wrong, she surprises him by stating that she enjoys her new life. “In here I can be myself, on every level, completely openly, without being rejected or mocked, and without the risk of not being taken seriously,” she explains. “I am not regarded as odd or as some kind of alien or some troublesome fifth wheel that people don’t know what to do with. Here I’m like everybody else. I fit in. I count. … I have a dignified life here. I am respected.” The unit has enticed her not with luxury, but with community—the sense that finally she’s not anomalous, but accepted. And as a narrator, she’s honest and intuitive enough to persuade readers that her appreciation of her new home is about much more than Stockholm syndrome.

In the last third of the novel an unexpected development comes out of the blue that offers a potential way out for Dorrit. The question is, does she want to leave? Holmqvist’s writing is spare in style, elegantly succinct, but the layers of the world she’s created are manifold. Other dystopian stories like The Handmaid’s Tale might seem particularly chilling in a moment when democracy feels like it’s under threat, but The Unit is haunting in its assertion that democracy itself isn’t enough. The tyranny of popular sentiment can be just as dangerous, Holmqvist argues, presenting scene after scene of intelligent, compassionate citizens indoctrinated into doubting their own worth.

“Life and existence have no value in themselves,” Dorrit’s friend Johannes tells her. “We mean nothing. ... The only thing of any real value is what we produce.” The question readers might ponder is whether he’s talking about art, children, or both.