Orders, decorations, and medals of the Holy See of the Catholic Church by his authority as head of the Holy See and sovereign of the Vatican City State. Historically, membership in these orders was either conferred by Papal bulls not signed by the Pope or by apostolic letters signed by the Pope himself. Since the reforms of these orders in the beginning of the 20th century, the diplomas have been signed by the Cardinal Secretary of State. In general, "Papal orders of knighthood" refers to the five equestrian orders of the Holy See awarded directly by the Supreme Pontiff as head of the Catholic Church, Holy See and
Foreign relations of the Holy See accredited also to the Holy See. For reasons of economy, therefore, smaller countries accredit to the Holy See a mission situated elsewhere and accredited also to the country of residence and perhaps other countries. Massimo Franco, author of "Parallel Empires", asserted in April 2009 that the Obama administration had put forward three candidates for consideration but each of them had been deemed insufficiently pro-life by the Vatican. This claim was denied by the Holy See's spokesman Federico Lombardi, and was dismissed by Thomas Patrick Melady, former United States Ambassador to the Holy See, as being in conflict with diplomatic practice.