Audio Transcript

Heather, a podcast listener, writes in to ask, “Pastor John, I know there have been episodes about God ordaining evil — episodes 104 and episode 204, and also episode 254 about whether God heals all of our diseases. But what I would like to know is this: Does God ordain all sickness, as in, does God cause all sicknesses to happen?”

Before I give a yes or a no, I need to make something clear that may not be clear in Heather’s mind. I don’t know. Maybe it is. But it is hugely important, and so I need to say it before I give the answer.

God’s Cause and Effect: Four Examples

In any answer — “yes” or “no” — we need to take into account that God’s causation is not simple. That is, it happens with multiple levels of secondary causes in between him, or his direct causing, and the effect. And I can think of four examples that I will give.

1. God can cause with no intervening causes.

First, God can cause directly with virtually no intervening causes. And the clearest example of that, of course, would be creation. He has created out of nothing. He didn’t use anything to create. Nothing came between his word and the thing that came into being.

2. God can direct other causes.

God can also use physical means where the direct intervention is further back in the chain. For example, in Acts 12:23, since Herod did not give praise to God, “An angel of the Lord struck him down . . . and he was eaten by worms” and died. This is clearly a punishment from God for not giving God glory.

So, you have between God and Herod two agents: angels and worms. Who caused the death? Answer: worms. Who caused the death? Answer: an angel. Who caused the death? Answer: God. So, there is an intervening of angelic or spiritual or physical secondary causes.

3. God uses Satan to accomplish his purposes.

Here is a third example: God never lets Satan out of his control and often uses him to accomplish his purposes. This was true for Job — Satan had to get permission to go hammer Job, and then Job said it was the Lord who had “taken away.” And the writer says he “did not sin or charge God with wrong” even though Satan was more immediately involved in the wind that blew down the house that killed the kids (Job 1:18–22).

And in 2 Corinthians 12:7, Paul says, “To keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me” — but what was the purpose of the thorn? — “to keep me from becoming too conceited.” Really? Satan wants you not to be conceited? No, no, no. God wants him not to be conceited. And Satan happens to be the instrument that God is using in this thorn to keep Paul from sinning. I am sure Satan did not appreciate that use, because that is exactly the opposite of what Satan designs in the thorn. If you have a thorn, Satan is designing your sin. God is designing your sanctification. So, Satan is one of God’s instruments in causality.

4. God can cause events through sinful people.

And lastly, God can control sinful people so that they are the immediate cause of whatever. This was the case with the crucifixion of Jesus. Herod, Pontius Pilate — they were all “gathered together . . . to do whatever your hand and your plan had predestined to take place” (Acts 4:27–28). So, all of these secondary causes are significant. The fact that God is the ultimate or the decisive cause does not make these secondary causes insignificant.

“If you have a thorn, Satan is designing your sin. God is designing your sanctification.”

For example, the fact that nicotine causes lung cancer means we can fight cancer by not smoking. Or, take the human instrument. Some dad may set a terrible example for his kid in smoking, or some friend has a terrible influence on you and mocks you because you are not smoking. And because of his influence, you smoke. Now you have nicotine, and you have a dad or an influential friend, and you can fight cancer by not smoking the nicotine and not hanging out with that friend. And if you do those two things, you are not fighting God even though God is the one who will finally control whether or not you get cancer.

So, to say that there are secondary causes is very significant because we can fight those causes. I think it is totally right for millions of dollars to be invested in looking for a cure for HIV/AIDS or cancer or malaria or polio or leukemia or anything like that because those are immediate. There are probably immediate physical causes behind each of those, and to fight those secondary causes does not mean we are fighting God. God can override or submit to that, and he would not be jeopardized in his sovereignty at all.

So my answer to Heather’s question is, Yes, ultimately God does, to use her words, cause all sickness to happen. But it might be a very distant cause, or it might be a more immediate cause, and those intervening causes are all relevant.