History of the award
Similar in name to the Medal of Freedom, but much closer in meaning and precedence to the Medal for Merit, the Presidential Medal of Freedom is currently the supreme civilian decoration in precedence in the United States, whereas the Medal of Freedom was inferior in precedence to the Medal for Merit; the Medal of Freedom was awarded by any of three Cabinet secretaries, whereas the Medal for Merit was awarded by the president, as is the Presidential Medal of Freedom.
President John F. Kennedy established the current decoration in 1963 through Executive Order 11085, with unique and distinctive insignia, vastly expanded purpose, and far higher prestige. It was the first U.S. civilian neck decoration and, in the grade of Awarded With Distinction, is the only U.S. sash and star decoration (the Chief Commander degree of the Legion of Merit—which may only be awarded to foreign heads of state—is a star decoration, but without a sash). The Executive Order calls for the medal to be awarded annually on or around July 4, and at other convenient times as chosen by the president, but it has not been awarded every year (e.g., 2001, 2010). Recipients are selected by the president, either on the president's own initiative or based on recommendations. The order establishing the medal also expanded the size and the responsibilities of the Distinguished Civilian Service Awards Board so it could serve as a major source of such recommendations.
The medal may be awarded to an individual more than once; Colin Powell received two awards, his second being With Distinction; Ellsworth Bunker received both of his awards With Distinction. It may also be awarded posthumously; examples (in chronological order) include John F. Kennedy, Pope John XXIII, Lyndon Johnson, Paul "Bear" Bryant, Thurgood Marshall, Cesar Chavez, Roberto Clemente, Jack Kemp, Harvey Milk, James Chaney, Andrew Goodman, Michael Schwerner, Elouise Cobell, and Grace Hopper. (Chaney, Goodman and Schwerner, civil rights workers murdered in 1964, were awarded their medals in 2014, 50 years later.)