In The Descent of Man, Darwin says: With savages, the weak…

““In The Descent of Man, Darwin says: With savages, the weak in body or mind are soon eliminated; and those that survive commonly exhibit a vigorous state of health. We civilized men, on the other hand, do our utmost to check the process of elimination; we build asylums for the imbecile, the maimed, and the sick; we institute poor laws; and our medical men exert their utmost skill to save the life of everyone to the last moment. There is reason to believe that vaccination has preserved thousands who from a weak constitution would formerly have succumbed to smallpox. Thus the weak members of civilized society propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man. It is surprising how soon a want of care, or care wrongly directed, leads to the degeneration of a domestic race; but excepting in the case of man himself, hardly anyone is so ignorant as to allow his worst animals to breed. This is pure Malthus. So is the demurral: “[We could not] check our sympathy, even at the urging of hard reason, without deterioration in the noblest part of our nature … We must therefore bear the undoubtedly bad effects of the weak surviving and propagating their kind…” None of this is abstract or general or innocent of political history or implication. The Descent of Man (1871) is a late work which seems to be largely ignored by Darwinists now.””

— Marilynne Robinson