Meaning of 手前 after ている verb

Question

I know 手前 has a bunch of meanings and can be used also as "considering, before" (as explained here and here), but I found a case in which I can't understand what it means:

完全看護を掲げている手前、付き添い婦は認められず、そうかといって看護の域はどこまでか、それをはみ出した部分はだれがするか、家族が毎日通って補助するしかない

The writer is the mother of a girl with a debilitating and progressive disease, and she is speaking about how, as her daughter's illness degenerated, the hospitals supported her less; I understand that in that sentence she is saying that an all-care is claimed, but in reality the hospital doesn't give a caretaker, so the family has to step up for anything that's outside of the care given in reality.

But what's the meaning of 手前? I can't understand it as any of the meanings I found, so I'm not sure how it fits in the sentence; I also tried a monolingual dictionary, but still nothing comes to mind.

Not sure if this is part of the problem, I don't really understand the そうかといって part.

Edit: I just had a thought, not sure if it's right: since 手前 is also "in front of", could it be it means "in front of", but in a figurative manner? Like saying that on the surface they claim a complete care, but that's a facade and the reality is different.

Not sure about the grammatical structure, for example in that case I would expect a "but" of some kind ("On the surface they claim a full care, but"), but if that's the case it would make sense.

Answer 1

As @aguijonazo points out in their comment, the third entry on your linked Weblio page of 手前 is what you are looking for. In this sense the word means "appearance", something that you've already done or a position that you have already taken, and as a result it affects other things.

So let's look at the examples in that entry

言い出した手前、とても断れない
[since] (someone, possibly the speaker) has already said/suggested that, it is impossible to turn it down now

If this isn't clear, let's fill in a made-up context. Say, your friend A san needs $500 to buy a present for their partner but they are cash strapped. You casually suggest you can lend them the money. A week later A san comes to you for the money, but you have just lost your job. You ask your other friend B san what to do. And in the discussion this line pops up. 「言い出した手前、とても断れない」

You suggested that you would lend A san the money, and now you can't refuse to do so. That's 手前. It sets up a situation, and the situation it explains affects other things said.

Let's look at your quoted line.

完全看護を掲げている手前、付き添い婦は認められず、そうかといって看護の域はどこまでか、それをはみ出した部分はだれがするか、家族が毎日通って補助するしかない

Your interpretation isn't exactly correct. Well, it's not that "the hospital doesn't give a caretaker." The original sentence claims the hospital doesn't approve of private caregivers.

So the hospital seems to claim total care, and as a result, they don't allow private nurses/caregivers (付き添い婦). But still the problem is there is no clear delineation of the hospital's care service scope. And there are things outside the scope of the total care provided by the hospital, and they have to be done too, but who is going to do those things is the question. 「家族が毎日通って補助するしかない」 There's no other way except that family members have to go to the hospital every day and do the extra work.