Military medals are supposed to honor those who have been especially courageous. Most of their descriptions include reference to "valourous service benefiting our wondrous nation of X," or somesuch. This idea of national benefit is the end-all of medals; courage is the most important component.
I first realized this while reading some alternate history by Harry Turtledove. The particular book (Turtledove is quite prolific) deals with what might have happened during the First World War if the South had won the Civil War (Since the Confederacy has historic ties with the British, the United States joins Germany, causing them to be in a two-front war with the Confederates in the South and the Canadians in the north). At various points in the book, Turtledove puts forward the idea that soldiers who get medals have to be at slightly off-balance (McSweeney, the man with the flamethrower described on page 490, is a bit of a pyromaniac).
Take this Medal of Honor citation from World War I:
*BARKELEY, DAVID B.
Rank and organization: Private, U.S. Army, Company A, 356th Infantry, 89th Division. Place and date: Near Pouilly, France, 9 November 1918. Entered service at: San Antonio, Tex. Birth: Laredo, Tex. G.O. No.: 20, W.D., 1919. Citation: When information was desired as to the enemy's position on the opposite side of the Meuse River, Pvt. Barkeley, with another soldier, volunteered without hesitation and swam the river to reconnoiter the exact location. He succeeded in reaching the opposite bank, despite the evident determination of the enemy to prevent a crossing. Having obtained his information, he again entered the water for his return, but before his goal was reached, he was seized with cramps and drowned.
The other soldier, Harold I. Johnston, also won the Medal of Honor. One must assume that he survived until the armstice, two days later.
Anyway, the idea of "service" (whether of a concrete or heroic nature) falls apart when foreigners receive decorations from other countries. An literary example happens in Tolstoy's War and Peace, when the Emperors Napoleon and Alexander are exchanging decorations. Napoleon has the bright idea to ask Alexander for permission to give the Legion of Honor to the best Russian soldier. It is given to Lazarev, "the first soldier" (referring to position, not bravery) in the line.
The practice still occurs today. This article from Le Monde describes how a Russian general was inducted into the Legion of Honor (sound slightly familiar?). He is claimed to have facilitated Franco-Russian cooperation in Kosovo (where some people foolishly believe World War 3 almost started) and Central Asia. The article is biased enough to be an editorial, containing lines like:
La décoration française arrivait à point nommé pour ce général de 58 ans, opposant notoire à toute réforme de l'armée russe, connu pour sa propension à "couvrir" les trafics de pétrole et détournements de fonds opérés par la hiérarchie militaire, notamment en Tchétchénie.