Heather, a podcast listener, writes in to ask this. "Pastor John, I know there have been episodes about God ordaining evil." Yes, episodes 104 and 204. "And also one about whether God heals all of our diseases." Episode 254. "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's hugely important, and so I need to say it before I give the answer. In any answer, yes or no, we need to take into account that God's causing, 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.

I'll give four examples. I think I can think of four. One, he can cause directly with virtually no intervening causes. And the clearest example of that, of course, would be creation. He's created out of nothing. He didn't use anything to create. Nothing came between his word and the thing that came into being.

Number two, he can use physical means where the direct intervention is further back in the chain. For example, 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." So you've got between God and Herod, and this is clearly a punishment from God for not giving God glory.

But you've got two agents, angels and worms. And so who caused the death? Answer, worms. Who caused the death? Answer, an angel. Who caused the death? Answer, God. So there's an intervening of angelic or spiritual or physical secondary causes. Here's a third example. God never lets Satan out of his control and often uses him to accomplish his purposes.

This was true for Job, where Satan had to get permission to go hammer Job. And then Job said it was the Lord that took away. And the writer says he didn't sin with his lips, even though Satan was more immediately involved in the wind that blew down the house that killed the kids.

And in 2 Corinthians 12, 7, it says, "To keep me," this is Paul, "to keep me from becoming conceited because of these surpassingly great revelations, there was given me a thorn in the flesh, a messenger of Satan to torment 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, 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'm sure Satan did not appreciate that use because that's exactly the opposite of what Satan designs in the thorn.

If you get a thorn, Satan is designing your sin, God is designing your sanctification. So Satan is one of God's instruments in causality. And the last one, number four, 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 says, Acts 4, 27, "They were all gathered together to do what your power and will had decided to take place." So all of these secondary causes are significant. The fact that God is the ultimate or the decisive cause does not make them, these secondary causes, insignificant.

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're not smoking. And so because of his influence you smoke.

So now you've got nicotine and you've got a dad or you've got 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're not fighting God. Even though God is the one who will finally control whether you get cancer or not.

So to say that there are secondary causes is very significant because we can fight those causes. I think it's 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 immediate physical causes probably behind each of those.

And to fight those secondary causes does not mean we're 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. Yes, thank you Pastor John and thank you for listening to this podcast and thank you for the very good question Heather. If you have a question for Pastor John, please email it to us at AskPastorJohn@DesiringGod.org. Before you ask your question, scan through the other 280+ episodes in the Ask Pastor John archive to see if your question has already been answered.

Those episodes are most easily found in the free Ask Pastor John apps for the iPhone and the Android. Be sure to update your app to get all the new features that make it really easy to search and browse all those episodes. I'm your host Tony Ranke. We'll be back tomorrow.

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