The question of patient agency in medical contexts demands frameworks that transcend the sterile dichotomy between mechanistic determinism and abstract libertarian autonomy. This essay builds upon my previous work on hermeneutic medicine, therapeutic tzimtzum, and the sacred-profane dialectic to reconceptualize patient agency as a relational, emergent phenomenon rather than an intrinsic property. Drawing on recent neuroscience (readiness potentials, addiction neurobiology), clinical realities (adherence challenges, chronic pain), and Jewish mystical theology (tzimtzum, Shekhinah, the broken vav), I argue that the therapeutic encounter itself creates the possibility space within which patient agency emerges. This framework has immediate implications for addiction treatment, medication adherence, and the moral dimensions of clinical practice, suggesting that the physician's role involves not assessing pre-existing capacity but co-creating conditions for maximal patient agency through therapeutic presence and sacred attention.