The Presidential Medal of Freedom is the nation's highest civilian award, which recognizes exceptional contributions to the security or national interests of the United States, to world peace, or to cultural or other significant public or private endeavors. Among all American honors, it ranks second to only the Congressional Medal of Honor, the nation's highest military award. The medal was established by President Truman in 1945 to recognize notable service in the war. In 1963, President John F. Kennedy reintroduced it as an honor for distinguished civilian service in peacetime. While the medal may be awarded for singular acts of importance, it is customarily given only for a lifetime of service or at the conclusion of a distinguished career. With this criterion, it was altogether fitting that the Medal of Freedom was presented to Herbert H. Lehman in 1964 for 35 years of service as both Lieutenant Governor (1928-1932) and Governor of New York (1933-1942), Director-General of the United Nations Rehabilitation and Relief Administration (1943-1946), and U.S. Senator from New York (1949-1956).

This particular award ceremony was significant in that it marked the reintroduction of the medal as a civil honor, but the occasion was also saddened by the absence of two men: John F. Kennedy, who had been assassinated during the previous November and Herbert Lehman himself, whose death in New York occurred just minutes before his departure to Washington to receive the award. Lehman's wife of over fifty years, Edith Altschul Lehman, journeyed to the White House and accepted the medal on her late husband's behalf.

As the medal was presented to Mrs. Lehman, President Johnson read, "The President of the United States of America awards this Presidential Medal of Freedom to Herbert H. Lehman, citizen and statesman. He has used wisdom and compassion as the tools of government and he has made politics the highest form of public service." Mrs. Lehman accepted the award and replied, "I can't tell you how honored I feel to accept this medal. I want to also say that the knowledge that this medal was coming to him added a great deal to his last hours of life." Among Lehman's fellow award recipients that year were: Thornton Wilder, Ludwig Mies van der Rohe, E. B. White, George Meany, Marian Anderson, Edward Steichen, Felix Frankfurter and the late President John F. Kennedy.