Established in 1963, the Presidential Medal of Freedom (PMOF) is the nation’s highest civilian honor. Presidents award the Medal at their discretion to “any person who has made an especially meritorious contribution to (1) the security or national interests of the United States, or (2) world peace, or (3) cultural or other significant public or private endeavors” (Executive Order 11085). Using an original database of all 1963-2013 PMOF recipients, we analyze how presidents exercise this symbolic unilateral power. In particular, we find that Democratic and Republican presidents differ in their recognition of various categories of achievement. Also, presidents have awarded a greater number of PMOFs annually in recent years, and it has become increasingly common to honor a large number of recipients in a single ceremony. While a strategic objective may be to attract positive media attention, our analysis indicates that PMOF ceremonies do not increase presidential approval ratings.