Phosphatidylcholine (PC) constitutes a major portion of cellular phospholipids and displays unique molecular species in different cell types and tissues. Inhibition of the CDP–choline pathway in most mammalian cells or overexpression of the hepatic phosphatidylethanolamine methylation pathway in hepatocytes leads to perturbation of PC homeostasis, growth arrest or even cell death. Although many agents that perturb PC homeostasis and induce cell death have been identified, the signaling pathways that mediate this cell death have not been well defined. This review summarizes recent progress in understanding the relationship between PC homeostasis and cell death.